ORAL ANSWERS TO QUESTIONS

NORTHERN IRELAND

The Secretary of State was asked—

Security

Tom Greatrex: What recent discussions she has had on the security situation in Northern Ireland; and if she will make a statement.

Theresa Villiers: Keeping people safe and combating the terrorist threat continue to be the Government’s highest priorities. While the threat level remains at severe, excellent co-operation between the Police Service of Northern Ireland and its partners has put violent dissident republicans under strain in recent months. There have been a number of significant arrests, charges and convictions, which are helping to suppress the threat.

Tom Greatrex: I thank the Secretary of State for her reply. When did she last discuss with the Home Secretary the issue of the National Crime Agency and its taking up functions in Northern Ireland? What assessment has she made of the effects of the delay on fighting organised crime in Northern Ireland?

Theresa Villiers: I last discussed that with the Home Secretary on Tuesday morning. There are some very good discussions under way between the Justice Minister, members of the Social Democratic and Labour party and the Home Secretary on these matters. There is some optimism that real progress is being made, and I urge all involved—I urge Labour to work with its sister party, the SDLP—to work on this, because the NCA provides excellent services. At the moment, Northern Ireland is not getting the full benefit of the protection that it can offer.

Andrew Robathan: The Secretary of State may have seen some rather surprising reports in the newspapers today. Given that she is talking about serious crime and is talking to parties in Northern Ireland about that, has she talked to Sinn Fein, because apparently the Labour party has been talking to Sinn Fein about a possible link-up after the general election? Did she see that?

Theresa Villiers: I was briefed on those stories in The Sun this morning. I certainly discuss many matters with Sinn Fein and the other Northern Ireland parties. It is crucial that all parties—Sinn Fein, the SDLP and all the
	parties in the Executive—get behind the introduction of the full powers of the National Crime Agency in Northern Ireland, because that is a means by which we can ensure that we do more to keep people in Northern Ireland safe, and it helps to relieve pressure on PSNI resources.

Nigel Dodds: One of the biggest threats to security in the months ahead in Northern Ireland is the continuing impasse over parades in north Belfast. Will the Secretary of State tell us what she plans to do, as this is not a devolved matter? The ball is firmly in her court after her decision at Christmas not to proceed with the north Belfast parading panel. She will know that on this side of the House we are determined not to allow this matter to be forgotten or swept under the carpet. It needs to be addressed, and the festering sore of the denial of human rights to people in north Belfast must be sorted out.

Theresa Villiers: I fully agree with the right hon. Gentleman that we cannot go on as we are—things cannot be left as they are. It is vital that we get a process in place that will help to resolve the dispute, deal with the impasse, and bring the two sides together. I am actively engaged on that, and I hope to meet him and representatives of the loyal orders soon to discuss this. I would urge a wide range of people to get involved. I accept full responsibility for seeking to drive it forward, but contributions by Church leaders have been helpful on this matter in the past. Other parts of Northern Ireland have demonstrated that input from the business community can be helpful in resolving these disputes. We need to develop an inclusive process that brings a range of interest groups together to try to find a way to resolve this dispute.

Nigel Dodds: On the issue that was the subject of exchanges a moment ago—I am grateful that the Secretary of State sees the Labour party putting pressure on the SDLP—Sinn Fein is the real impediment, with a veto in the Northern Ireland Assembly in relation to the NCA. What does the Secretary of State intend to do about that? Is there not a more active role for her to play in resolving this issue, and what confidence can we have in Sinn Fein being prepared to support the NCA when one of its leading members, Gerry Kelly, having promised support and help for a victim’s family, ran around giving letters of comfort to the alleged perpetrator against the innocent family?

Theresa Villiers: I have been very actively involved in these matters for many months, and I raise the issue with Sinn Fein virtually every time I have a conversation with them. It essential that we see movement on this. The reality is that it will be more difficult to seize the assets of criminals without full implementation of the NCA. It will be more difficult to crack down on drug dealing, racketeering and serious organised crime without full powers for the NCA. I will continue to urge Sinn Fein and the SDLP to accept the extension of the NCA’s remit. The reassurances in place ensure that any activity by the NCA will be entirely consistent with the devolved policing and justice settlement.

Lady Hermon: What additional measures have been put in place by the UK Border Force to enhance the security of this country to ensure that young British people who go out to Syria or Iraq
	and become radicalised jihadists there could not easily slip back into the Republic of Ireland, cross the border with Northern Ireland back into the UK and commit the most appalling acts of terrorism? What is being done to improve that situation?

Theresa Villiers: My right hon. Friend the Home Secretary has a range of measures in place on those matters, including the Counter-Terrorism and Security Bill which is under discussion in Parliament, which in certain circumstances would enable UK nationals not to be admitted back into the country. The hon. Lady is right to raise the threat from international terrorism, which we must remember is a threat in Northern Ireland as it is elsewhere in the United Kingdom. I had the opportunity to discuss these matters with senior members of the PSNI last week. They stand ready not only to play their part in Northern Ireland, but to provide assistance and advice to police services in the rest of the country.

PSNI

Rosie Cooper: What recent steps she has taken to ensure that the Police Service of Northern Ireland has adequate resources to guarantee security for the people of Northern Ireland.

Theresa Villiers: The Stormont House agreement included an undertaking by the Northern Ireland Executive to protect the PSNI’s budget from significant reductions. I very much welcome the additional £20 million for the police in the Executive’s final budget for 2015-16. This is in addition to security funding of £231 million provided by this Government to help the PSNI tackle the terrorist threat.

Rosie Cooper: The letter bomb sent to the PSNI headquarters earlier this month is a shocking reminder of the great sacrifices made by officers across Northern Ireland. How closely is the Secretary of State monitoring the resource needs of the PSNI?

Theresa Villiers: This is of course something I take a very close interest in. That is one of the reasons why the Government have provided the extra security funding and why we included provision in the Stormont House agreement to link our funding package with a commitment by the Executive on police resources. Clearly, the threats to police officers continue to be real and significant, and I welcome the success that the PSNI and An Garda Siochana have had in significant arrests and disruptions, which I believe have contributed substantially to suppressing the terrorist threat.

Mary Glindon: How can the PSNI possibly meet its resource requirements to keep the peace when it has to make budgetary savings of over £51 million by the end of this financial year?

Theresa Villiers: As I said, the resource position for the police has been improved with the changes in the draft final budget. The position of the police would be further improved if the NCA were to operate to its full capacity in Northern Ireland, because at present the PSNI is
	doing work that would otherwise be done by the NCA. The establishment of the Historical Investigations Unit in the coming months will further relieve the PSNI of responsibilities in relation to policing the past, freeing up time and resources for policing the present.

David Simpson: Does the Secretary of State agree that as well as securing resources for security for the PSNI, we need to focus on rural crime, attacks on our elderly and the drugs issue, all of which are increasing in Northern Ireland?

Theresa Villiers: These matters are crucially important. The crime figures in Northern Ireland continue to make it clear that Northern Ireland is one of the safest places in Europe and has some of the lowest levels of crime, but I know that the PSNI takes very seriously the regular crime that is the bane of people’s lives and is working hard to combat it, in addition to its duties in relation to national security.

Naomi Long: The hon. Member for West Lancashire (Rosie Cooper) referred to the attack on PSNI headquarters in my constituency. In addition to being under threat when in uniform and on duty, officers are often under threat in their own homes. The PSNI needs resources to be able to provide adequate security measures at officers’ homes if it is to retain officers who have been trained. What can the Secretary of State do to allow additional funding for the PSNI to ensure that that happens?

Theresa Villiers: As I said, one way to do that would be to take burdens off the PSNI’s shoulders by implementing the NCA. Continued focus on trying to resolve parading disputes is also important, given their potential impact on police resources. It is crucial that we get the new institutions on the past up and running as soon as possible to provide that relief to PSNI funding, and, as we discussed in the House yesterday, we need to consider whether any of the £150 million for dealing with the past can be deployed prior to the establishment of the HIU to help on these matters for the PSNI.

Ivan Lewis: The Conservative party seems to want to introduce new protocols to the House, believing everything in The Sun and demanding that the Labour party take responsibility for problems that are clearly the responsibility of the Government.
	Yesterday, the Secretary of State was unable to tell us how long it would take the PSNI to review the case of all those covered by the on-the-runs scheme. When will she be able to answer that question? In lieu of the creation of a new architecture to deal with the past, what will the PSNI be doing in the meantime to deal with some of the unresolved murders?

Theresa Villiers: How to deal with such cases, the priority given to them and the length of time it will take are matters for the PSNI, but it has said publicly that it will take some years to progress through the cases under Operation Redfield. As I told the House yesterday, it is important for us to consider whether any of the £150 million that is to be devoted to matters relating to legacy cases can be used to assist the PSNI in its work prior to the establishment of new institutions to look at past cases.

Voluntary Sector

David Mowat: What assessment her Department has made of the role of the voluntary sector in dealing with the legacy of the past.

Andrew Murrison: Voluntary sector organisations provide invaluable support for those whose lives have been changed forever as a result of Northern Ireland’s troubled past. I have visited some of them and I pay tribute to their work, which I know from my dealings with victims and their families is deeply appreciated by many in Northern Ireland and beyond.

David Mowat: The recent Stormont agreement acknowledged that victims of the troubles from outside Northern Ireland should also be formally recognised, and the oral history archive that is to be set up is a mechanism for doing that. Will my hon. Friend support a role for the Warrington-based Foundation for Peace in co-ordinating input to the archive for such victims?

Andrew Murrison: Yes, and I pay tribute once again to my hon. Friend’s contribution to this and his support for the Warrington peace centre and its important work. It is explicit in the Stormont agreement that the oral history archive will be established for the whole of the United Kingdom, and it will be keen to hear the accounts of the troubles of people in Warrington and throughout the United Kingdom. I look forward to that forming a part of the oral history archive in due course.

Peter Hain: Do the Government agree that the provision of a special pension for those severely injured during the troubles who were unable to build up an occupational pension of their own, long argued for by the WAVE trauma centre’s injured campaign group and included in the Stormont House agreement, should be supported by all parties, and that questions around who should be eligible for that pension can be resolved to ensure that those who were severely injured through no fault of their own are not denied the opportunity to have some financial independence as they grow older?

Andrew Murrison: As the right hon. Gentleman will know, because he will have read the Stormont agreement, this item was left largely unresolved, although open. I am afraid to say that the problem revolves around the definition of victims, notwithstanding the 2006 order. That is work in hand and it is something that we will have to return to.

Laurence Robertson: May I join the Minister in paying tribute to all the many charities and voluntary organisations in Northern Ireland, which, as he rightly says, have done so much invaluable work over the years? What recent review has he done of the potential for the Civic Forum for Northern Ireland to contribute to bringing people together in Northern Ireland?

Andrew Murrison: My hon. Friend is right to refer to the Civic Forum. It is clear that we need to hear those voices in Northern Ireland, which is a part of the United Kingdom where politicians are not necessarily
	all held in high regard, Members of this House excepted. It is important that we look for alternative voices, and I am sure that in the months and years ahead, with the assistance of the Stormont agreement, that civic voice will be heard more and more.

Sammy Wilson: Does the Minister agree that we will never deal with the hurt and the poison of the past in Northern Ireland while the past actions of police and Army officers and personnel are subject to extensive investigations, police investigations and court action, while terrorists are given letters that enable them to escape the consequences of their crimes?

Andrew Murrison: The hon. Gentleman makes his points in his usual robust fashion. It is clearly important that justice is done in Northern Ireland as it is throughout the United Kingdom, and that when there are failings they are properly investigated.

Historical Records

Mark Durkan: What steps she is taking to safeguard records relevant to the work of the Historical Investigations Unit, the Independent Commission for Information Retrieval, inquests, and other inquiries into the past.

Theresa Villiers: The Northern Ireland Office takes responsibility for safeguarding its records very seriously and will continue to follow existing protocols.

Mark Durkan: The Secretary of State gave the commitments on behalf of the British Government in the Stormont House agreement to ensure that whenever the new mechanisms come into place all records will be given to them. What steps is she taking to make sure that all current records will still be available? She knows that there have been many cases where files or their contents have disappeared, to the dissatisfaction of those dealing with them. What steps is she taking to safeguard against that?

Theresa Villiers: The Northern Ireland Office undertook a review of record keeping in the wake of the problems that occurred in relation to the cases involving the RPM—royal prerogative of mercy. We are satisfied that all necessary measures are in place to ensure that records will be available for transfer as appropriate, but we will also take steps to make sure that sensitive material is protected from onward disclosure by the institutions concerned.

William McCrea: In 1976, 10 innocent Protestant workmen were brutally slaughtered by the side of the road at Kingsmills. The Historical Enquiries Team report now reveals the chilling fact that a large number of the terrorists responsible included neighbours based in the village of Whitecross just over 1 mile from the scene of the atrocity and close to where many of the innocent victims lived. Does the Secretary
	of State not accept that it is sickening to think that these men were part of that murdering team, when the victims needed neighbours to be faithful most of all?

Theresa Villiers: The Kingsmills tragedy was an appalling terrorist atrocity. I have met the families, and they have my deepest, deepest condolences. Every effort should continue to be made to bring to justice those responsible for this horrific episode in the troubles.

Stephen Pound: Further to the question by my hon. Friend the Member for Foyle (Mark Durkan), I am sure that the whole House welcomes the new architecture proposed as a result of the Stormont House agreement. Will the Secretary of State give us some indication of the time scale and, crucially, say whether it will require legislation in this House? Frankly, the victims’ families have waited too long—they need answers and they need them now.

Theresa Villiers: I am meeting the leaders of the Northern Ireland parties on Friday to agree an implementation plan on the Stormont House agreement. It is highly likely that we will need at least some legislation both in Westminster and in the Assembly. We will talk to the Northern Ireland Executive about the balance between the two to ensure that we get these institutions up and running as soon as possible, because current systems are not giving the right outcomes for victims, and that needs to change.

Stormont House Agreement

William Bain: What progress she has made on implementation of the Stormont House agreement; and if she will make a statement.

Theresa Villiers: The Government are committed to timely implementation of the Stormont House agreement and we are making progress—for example, on corporation tax devolution. We hope to agree an implementation plan for the agreement at our first formal review meeting with the parties on 30 January.

William Bain: I welcome the Stormont House agreement as further strengthening devolution across the United Kingdom and offering the Northern Ireland Executive nearly £2 billion in new finance and loans. What process will the Secretary of State propose to deal with the unresolved issues of parades, flags and cultural identity?

Theresa Villiers: The SHA sets out a clear pathway for reaching a resolution of those issues with the commission on flags, which was first proposed by Dr Richard Haass. It is right that we have a broader engagement with the public on the matters relating to identity. The SHA commits the Executive to producing options for a new system of parading that could be devolved, we hope, in future.

Gregory Campbell: Does the Secretary of State agree that the Stormont House agreement, with the boost to the economy that should come as a result of the corporation tax decision, the reduction in the size of Government, and the provisions
	on no rewriting of the past and no expansion of cross-border bodies, means that we now have a once-in-a-generation opportunity to make significant progress in Northern Ireland?

Theresa Villiers: I wholeheartedly agree with the hon. Gentleman’s description of the Stormont House agreement. It was balanced and fair, it comes with a significant financial boost for Northern Ireland, and it guards against the dangers of those who would attempt to rewrite history. Corporation tax devolution could be genuinely transformative for Northern Ireland as a place sharing a land border with a low-tax jurisdiction.

Margaret Ritchie: Further to the question on corporation tax, will the Secretary of State have immediate discussions with the Northern Ireland Executive to force home the point that that lever should be used to bring about balanced regional development in terms of inward investment locations for projects? [Interruption.]

Mr Speaker: Order. Let us make sure we hear the Secretary of State’s answer on the Stormont House agreement.

Theresa Villiers: Both the UK Government and the Northern Ireland Executive are united in our efforts to rebalance the Northern Ireland economy, and we both share the determination to ensure that economic prosperity and the boost that will come with corporation tax devolution are shared throughout all towns, cities and rural areas in Northern Ireland.

Ivan Lewis: The Stormont House agreement states that corporation tax devolution will not take place until 2017, subject to various conditions, so will the Secretary of State tell the House what tangible benefits the economic pact has so far delivered to Northern Ireland’s economy? When did she last meet the Business Secretary and the Foreign Secretary to talk about how the UK Government can support Invest Northern Ireland?

Theresa Villiers: I regularly discuss such matters with my colleagues in Cabinet. We have rolled out a range of measures under the economic pact—devolution of corporation tax is one, and the investment conference following up on the G8 is another. We are seeing real progress on projects such as the Lisanelly shared campus, as well as increased take-up of the Government’s financial schemes to promote lending to business, so the economic pact is already delivering for Northern Ireland in a range of ways.

Youth Unemployment

Pamela Nash: What steps the Government are taking to tackle youth unemployment in Northern Ireland.

Julie Hilling: What steps the Government are taking to tackle youth unemployment in Northern Ireland.

Alex Cunningham: What steps the Government are taking to tackle youth unemployment in Northern Ireland.

Andrew Murrison: The questions are timely because last week’s figures show that youth unemployment in Northern Ireland has fallen by 3.3 percentage points over the year, and is 175,000 lower than in May 2010. The Government’s long-term economic plan is promoting a sustainable economic recovery from the mess we inherited, and it is directly assisting young people into real jobs that have a future.

Pamela Nash: I welcome those youth unemployment figures. However, Northern Ireland’s youth unemployment figures remain significantly higher, at 19.2%, than in the rest of the UK. That has a big impact not only on those young people, but on the security of Northern Ireland. Why have the Government allowed this situation to persist, and what will they do to stop it?

Andrew Murrison: The matter to which the hon. Lady refers is of course primarily the responsibility of the Northern Ireland Executive. I must observe, however, that unemployment among young people in Northern Ireland rose by 35% between May 1997 and May 2010; it has gone down by 3.3 percentage points in this year alone.

Julie Hilling: Last week’s labour market statistics show a worrying growth in female unemployment. What are the Government doing to address that imbalance?

Andrew Murrison: Female unemployment is of course a concern right across the United Kingdom, as is unemployment in general. I would observe the number of apprenticeships being created by this Government. It is important that we get young people, male and female, into jobs for the long term, and not indulge in short-term gimmicks.

Alex Cunningham: The chief economist of Ulster Bank has said that under-25s are failing to participate in Northern Ireland’s labour market recovery. Does the Minister agree that we need to address young people’s prospects, and will he welcome the Heenan-Anderson commission, which will examine skills and education?

Andrew Murrison: I certainly welcome any comments from any commission that are worth reading. I would add that the commission recently set up by the Labour party to look into problems in Northern Ireland, chaired by Deirdre Heenan, has started somewhat poorly. She said by tweet, within minutes of being appointed, that the
	“key issue for Labour is a lack of distinct policies”.

Inward Investment

Bob Blackman: What steps the Government are taking to strengthen the economy of and increase inward investment to Northern Ireland.

Theresa Villiers: The Government’s long-term economic plan is working for Northern Ireland, as shown by the good
	news on employment statistics last week. We have introduced a Bill to devolve corporation tax-setting powers, which will act as a significant marketing tool to attract foreign investment to Northern Ireland.

Bob Blackman: I thank my right hon. Friend for that answer. Does she agree that reducing corporation tax rates would enable greater employment prospects and a brighter future for the people of Northern Ireland?

Theresa Villiers: I agree with my hon. Friend. That change has great potential to transform the Northern Ireland economy, which is already starting to recover. Since the election, employment is up by 31,000, private sector employment is up by 51,000 and unemployment is down 6,000, and the claimant count in Northern Ireland has gone down for 24 consecutive months.

Alasdair McDonnell: The Secretary of State will be aware that strengthening the economy and increasing investment require multiple factors, not just the reduction of corporation tax. Does she appreciate how critical regional connectivity is, particularly the air links between Belfast and London and Dublin and London that go into Heathrow? Will the Heathrow slots be protected if International Airlines Group takes over Aer Lingus?

Theresa Villiers: It is not for me to speak for IAG, but it is vital that Heathrow maintains its links with Belfast and Dublin. I agree that a corporation tax reduction on its own is not enough for economic recovery; it is crucial that economic reform and investment in infrastructure accompany that change.

Mr Speaker: Last but not least, on the Union flag, I call Kate Hoey.

Union Flag (Driving Licences)

Kate Hoey: What recent representations she has received on use of the Union flag on driving licences in Northern Ireland.

Andrew Murrison: I understand the strong interest in whether proposals for the Union flag to appear on driving licences in Great Britain should apply in Northern Ireland. However, driver licensing is a devolved matter for Northern Ireland and it is for Executive Ministers to decide whether to adopt the changes that have been announced for the rest of the country.

Kate Hoey: The Minister will know that there is doubt over whether this is a devolved matter. Surely, if we believe in the Union, people in Northern Ireland should have the same right as everyone else in the United Kingdom to have the flag of their country flying on their driving licence. Does he agree?

Andrew Murrison: I share the hon. Lady’s sentiments about the importance of the Union flag. However, I emphasise that putting it on driving licences is a devolved matter and therefore a matter for the Executive.

PRIME MINISTER

The Prime Minister was asked—

Iraq Inquiry

Frank Field: When he next plans to meet the chairman of the Iraq inquiry; and if he will make a statement.

David Cameron: I have no current plans to do so.

Frank Field: Given that the current Cabinet Secretary said in 2009 that, in his judgment, the inquiry would take a year and that there will have been two general elections before we see the report, might I ask the Prime Minister to write to the chairman to get a date for when the report will be handed to the Prime Minister and then published?

David Cameron: I have written to the inquiry chair and expressed my frustration. However, I say to the right hon. Gentleman that it is not for this Government to interfere in how the inquiry, which was set up with terms of reference by the last Government, is conducting itself. That would not be right. I first voted for an inquiry back in 2006. Labour Members, including the Leader of the Opposition, voted against it in 2006, 2007 and 2008. Even as late as 2009, they were still voting against an inquiry that would have been here, discussed, debated and finished by now.

Engagements

Lilian Greenwood: If he will list his official engagements for Wednesday 28 January.

David Cameron: This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.

Lilian Greenwood: My constituents keep telling me that their No. 1 concern is what is happening to our national health service. In Nottingham and across the country, essential services are at breaking point. Given that our NHS did not even make the Prime Minister’s top six priorities for the election, should not everybody who cares about our NHS vote Labour on 7 May?

David Cameron: What people need to know about our NHS is that it is this Government who decided to invest in the NHS, ignoring Labour’s advice to cut it. In Nottingham, compared with 2010, there are 158 more doctors, 646 more nurses and the NHS is doing well. What a contrast with Wales, where Labour is in charge—[Interruption.] I know that Labour Members do not like to hear it, but they have cut the NHS by 8% in Wales. Because of Labour, the NHS is doing worse in Wales than in England.

Bob Blackman: Yesterday marked the 70th anniversary of the liberation of Auschwitz-Birkenau. I welcome my right hon. Friend’s acceptance of all the recommendations from the Holocaust
	Commission, which was set up by this Government. Will he in particular make sure that the lasting monument to that terrible tragedy is accessible throughout the United Kingdom and will he safeguard the funding for the Lessons from Auschwitz project, so ably put together by the Holocaust Education Trust?

David Cameron: I am sure that my hon. Friend speaks on behalf of the whole House and indeed the whole country in wanting to commemorate properly the 70th anniversary of the liberation of Auschwitz, and to ensure that here in Britain we properly commemorate the horrors of Auschwitz for years to come. The Leader of the Opposition, the Deputy Prime Minister and I were privileged to meet so many survivors yesterday with the extraordinary stories that they have to tell, but they cannot go on telling those stories for ever, so it is vital that we record their testimony; that we make sure that education about the holocaust is maintained; that we establish this national monument, for which three places have been identified; and that this work goes head, starting now with all-party support.

Edward Miliband: Let me first associate myself with the remarks of the hon. Member for Harrow East (Bob Blackman) and the Prime Minister. Yesterday was an incredibly moving and emotional day for anyone who was part of the commemoration. I thank the Prime Minister for the work that has been done as part of the Holocaust Commission and I can confirm absolutely that it will be taken forward on a cross-party basis so we do indeed keep the memory alive.
	Before the last election, the Prime Minister said that he would have a “bare-knuckle fight” to save 29 accident and emergency and maternity units, and he published a list. Can he assure the House that in line with his promise all those services have been protected?

David Cameron: I am glad that the right hon. Gentleman has mentioned the NHS, because before we go any further he needs to clear something up. He has now been asked nine times whether he made the disgraceful remarks about weaponising the NHS. Everyone in the House and, I suspect, everyone in the country knows that he made those remarks, so he should get up to the Dispatch Box and apologise for that appalling remark, and then we can take this debate forward.

Edward Miliband: The only person who should be apologising is the Prime Minister who has broken all his promises on the national health service. He did not give us an answer: he toured the country, standing outside hospitals and promising that services would remain open. Let me tell him about a few of those services. The A and E at Queen Mary’s hospital in Sidcup is now closed. The maternity unit in Ilford is closed. The A and E unit in Welwyn is closed. Why did he break his promises?

David Cameron: It is very simple: one of the most respected political journalists in Britain, Nick Robinson, the political editor of the BBC, said—and I shall quote it however long it takes—
	“A phrase the Labour leader uses in private is that he wants to—and I quote—‘weaponise’ the NHS for politics.”
	That is one of the most respected journalists in our country. Will the right hon. Gentleman now get to the Dispatch Box and apologise for that appalling remark?

Edward Miliband: This is a ridiculous smokescreen from a Prime Minister running from his record on the NHS. The answer—because this is Prime Minister’s questions—is that all those units have closed. Let me give him another one. He stood outside the A and E unit at Chase Farm, with the local MP, saying, “Hands off our hospital. No to cuts, no to closure.” Is the A and E at Chase Farm open or closed?

David Cameron: I will tell the right hon. Gentleman my record on the NHS—9,000 more doctors, 6,000 more nurses, hospital-acquired infections right down, investment in our health service up. People rightly want to know what his motives are when it comes to the NHS. If his motives are that he cares about this great national institution, that is fine, but he told the political editor of the BBC that he wanted to weaponise the NHS. I ask him again: get up there and withdraw.

Edward Miliband: I will tell the right hon. Gentleman what my motive is: it is to rescue the national health service from this Tory Government. Frankly, this is a man who has got a war on Wales and is using the Welsh NHS to make political propaganda. This is a man who has broken—[Interruption.]

Mr Speaker: Order. For the avoidance of doubt, however long it takes, the questions from the Leader of the Opposition will be heard and so will the answers from the Prime Minister. That is the situation and the sooner people learn that quite simple lesson the better.

Edward Miliband: We know the Prime Minister is in a hole on the NHS and this is all he can offer the British people. It is time we had some answers from him. He has broken his promises on waiting times in A and E. He could not defend what he said about maternity and emergency services. Can he explain why this morning new guidance has been issued to some hospitals making it harder for them to declare a major incident?

David Cameron: Let me answer that very directly. The NHS in the west midlands, without any instruction from the Department of Health and without any instruction from Ministers, issued a statement about major incidents. The head of NHS England was asked about it this morning and she said this:
	“I haven’t been under any political pressure. This document was issued…in the west midlands.”
	What a contrast between the operational managers of the NHS and the man who wants to weaponise the NHS.
	The right hon. Gentleman mentioned Wales. He criticised me a moment ago for mentioning Wales. He seems to have forgotten that yesterday he said this to the BBC: “It is right to look at problems in Wales and to compare”. That is what he said yesterday. Now, let us look at what happened today in Wales. The Welsh ambulance service statistics have come out and they are the worst ever on record: just 42% of emergency calls are answered
	in time, compared with 70% in England. Will he now admit that Labour’s catastrophic cuts and mismanagement in Wales have cost the NHS dear?

Edward Miliband: The last time the right hon. Gentleman was in charge in Wales, people were waiting two years for an operation. That is the comparison—with what was happening. Everyone will have heard that he did not answer the question about what is happening in the NHS in England. This is what the head of operations at one NHS hospital says:
	“This is the enhanced criteria that have been introduced by NHS England to…stop trusts from calling a major incident.”
	The whistleblower says the hospital’s hands are being tied. The Prime Minister says they are not. Who does he think people will believe?

David Cameron: People will believe the head of NHS England, who said this very clearly this morning:
	“Local hospitals continue to have responsibility for deciding whether to declare major incidents”.
	It is perfectly clear what is happening: the right hon. Gentleman is clasping at straws because he is in a desperate mess on the NHS. He talks about Wales. Here is the record: per head of the population, 10 times more people in Wales on a waiting list for an operation; nearly twice as many ambulances failing to meet those urgent calls; almost twice as many people waiting for more than four hours for A and E. That is what is happening in the NHS in Wales because Labour Ministers cut its budget. But the reason he is in such a mess on the NHS is this: a week ago the shadow Chancellor said that every penny from their new homes tax would go into the NHS. Yesterday, the leader of the Labour party said he had a plan to pay down the deficit with tax changes such as the mansion tax they have announced. There we have it: 99 days to go before the election and they cannot even have a sensible policy on the NHS. What a completely useless Opposition.

Edward Miliband: We have 99 days to kick out a Prime Minister who has broken all his promises on the NHS. Today’s revelation shows once again that, under him, the NHS is in crisis and under strain. It is a crisis of his making and on his watch, which is why nobody will trust him with the NHS ever again.

David Cameron: What a contrast—the Government dealing with the unions to stop the action in the NHS, and a Labour party weaponising the NHS. That is what everyone can see. The right hon. Gentleman talks about what has happened this week. We have seen Labour casting around for a coalition with the SNP and a coalition with Sinn Fein—the first time Britain would have people who want to break up Britain and bankrupt Britain. What a useless shower.

Stephen Gilbert: Watching that, I am reminded of that famous Stealers Wheel line:
	“Clowns to the left of me, Jokers to the right”.
	Eight months ago, the Secretary of State for Communities and Local Government assured people in Cornwall that the delay over resolving the EU funding programme
	would be settled. Eight months later, hundreds of millions of pounds of investment and hundreds of jobs are at risk. Will the Prime Minister please sort out this pickle?

David Cameron: I have done my best to run a coalition Government, but I occasionally feel stuck in the middle with the Liberal Democrats.
	The Government are delivering for the west country: we are sorting out the transport links and the local growth deals; putting money into road and rail connections; and helping with the vital airport and the routes back to London—and we will go on, because we want to close the income gap between the south-west and the rest of our country.

Lyn Brown: Care workers deliver the most basic support needed to provide a life of dignity to so many—bathing, cleaning, dressing, feeding—yet 300,000 fewer older people are enjoying that dignity now than four years ago. Is that because they do not need it, or because the Prime Minister has cut care budgets by £3.5 billion, while cutting taxes for millionaires?

David Cameron: The Government have put £3.2 billion of health money into social services, and the Better Care fund will start on 1 April, putting £5.3 billion into social care—something Labour argued should be delayed. However, there is a question that the hon. Lady has to answer. The shadow Chancellor said—he could not have been clearer—that
	“there will be no additional funding for local government”,
	which includes social services,
	“unless we can find money from somewhere else…but we have not been able to do that in the case of local government.”
	This is what Labour does. It goes round the country, promising more money for this, more money for that, and in its few moments of honesty, it reveals that it has not got any more money.

David Tredinnick: Does my right hon. Friend recall that, not long after the liberation of Auschwitz, the British Army liberated another camp, Bergen-Belsen, freeing 60,000 starving inmates, many of whom were saved by British medical services? Does he also recall that our allies at the time, the Russians and the countries of the former Soviet Union, in their struggle to defeat Nazi Germany, lost 40 million civilians and soldiers? Should we not pay them some tribute too?

David Cameron: My hon. Friend is absolutely right. We should pay tribute to all those who helped to defeat the evil of Nazi Germany. It is a good day to pay tribute to the British soldiers who liberated Bergen-Belsen. At the Holocaust memorial event yesterday, a tape of Richard Dimbleby’s incredibly moving testimony of what he and those soldiers found at Belsen was played for everyone to hear, and we should be very proud of the role that British soldiers played in liberating these appalling death camps.

Sandra Osborne: Last week, the Institute for Fiscal Studies revealed that poorer families had lost most under the Prime Minister’s tax and benefit policies. What happened to his promise that this Government would be the most family friendly ever?

David Cameron: The IFS report found that the richest had paid the most to reduce the deficit, so we should be clear about the figures: the richest 20% have paid more to reduce the deficit than the remaining 80%. If the hon. Lady wants to quote the IFS, she might want to remember that it said:
	“We’ve had a great big recession. We had the biggest recession we’ve had in 100 years…it will be astonishing if household incomes haven’t fallen and earnings haven’t fallen”.
	That is the view of the IFS, and it is right. It also says that the shadow Chancellor’s plans are for an extra £170 billion of borrowing, so if Labour is going to quote the IFS, it should accept its figures for more spending, more borrowing and more debt—all the things that got our country into this mess in the first place.

Richard Harrington: The Prime Minister will be aware that Watford GPs were among the first in the country whose practices received money under the Prime Minister’s challenge fund, so that GPs’ surgeries can be open seven days a week from 8 o’clock in the morning till 8 o’clock at night. I would like to commend Dr Mark Semler, who is the mastermind behind this. I hope the Prime Minister agrees that it should be continued and would be absolutely excellent for all GPs’ surgeries in the country.

David Cameron: My hon. Friend is absolutely right. The challenge fund we have set up has already allowed 4 million people access to a GP surgery seven days a week, from 8 in the morning to 8 in the evening. I am delighted that people are benefiting from this in Watford; I want to see it spread right across the country. It would be an important part of the answer to relieving pressure on our A and E units as well.

Dennis Skinner: If the Prime Minister will not apologise for the A and E closures, maybe he will have a go at the following subjects. Why is it that we have a record number of people queuing up at food banks? Will he apologise to them? Will he apologise to those who are on payday loans, struggling to pay them back? Will he apologise to those on zero-hours contracts, another record number? The truth is that this Prime Minister has got a longer record than his mate Andy Coulson.

David Cameron: The hon. Gentleman mentions zero-hours contracts. The Government he supported did nothing about them; we have legislated. He mentions payday lending—an industry that boomed under Labour; regulated properly under this Government. He talks about queues. What about the queue of people who have been getting jobs under this Government—over 1,000 a day?
	I have to say, I thought the hon. Gentleman might have taken a different tack today, because if you read the newspapers, you can get quite nostalgic. You’ve got Blairites fighting Brownites; you’ve got Peter Mandelson taking out a great big loan. I thought the hon. Gentleman might get all nostalgic on us; it is just like the old days.

Tim Yeo: Britain’s economic success is making it possible for the northern powerhouse to transform the fortunes of an important part of our country. Does my right hon.
	Friend agree that investment in science, such as in the new institute for advanced materials—the Henry Royce institute—supports our top universities and will promote innovation, which will bring back high quality manufacturing jobs to the north of England?

David Cameron: My hon. Friend is absolutely right to raise this. One of the most important decisions we took while making difficult spending decisions was to maintain the investment into science. We have also improved our universities by making sure they are properly funded. This combination of science and universities is going to be an absolute key to Britain’s future economic success. I am delighted that we have got the £235 million investment into the new Sir Henry Royce Institute for Materials Research and Innovation in Manchester. This is a key part of the northern powerhouse project, which is going to properly rebalance our economy and make sure we see growth and prosperity in every region.

Louise Ellman: Absolute poverty up by 300,000, the rise of the working poor and very seriously sick people impoverished while they wait for their benefit—is the Prime Minister proud of this record?

David Cameron: I am afraid that the hon. Lady’s statistics are simply wrong. I know Labour does not like to hear this, but the fact is that there are 600,000 fewer people in relative poverty than there were at the election and 300,000 fewer children in relative poverty. Inequality is lower than it was at the election and we can now see 1.75 million more of our fellow countrymen and women in work. Behind all those statistics are people who are able to go out, earn a wage, have a pay packet and support their families. I would have thought the Labour party of all parties would want to support that.

Simon Hart: My constituent, Kelly Thomas, has been waiting nearly 15 months for urgent bowel surgery, which, if she lived in England, she could have had in six weeks. NHS Wales refused her treatment on the basis that it is technically available in Wales, although ironically there are no surgeons available to do it. Someone somewhere needs to make a common-sense and humane decision. I hope the Prime Minister can help that happen.

David Cameron: I will look at this case. It sounds as if it is a very sad case but, I am afraid, not an isolated case. As the Welsh National Audit Office found, overall, Welsh patients face shorter waits for treatment in England than they do in Wales. That is a fact. What we need is a change of direction in Wales from the Labour Administration: instead of cutting the NHS, they should be investing in the NHS; instead of leaving the bureaucracy in place, they should be taking it out of the NHS. In short, they should be taking a different track, so that we give people a better NHS.

Madeleine Moon: Yesterday, Mr Speaker graciously allowed the all-party parliamentary group on motor neurone disease to use his state apartments for the launch of its report, which demonstrates that people with motor neurone disease are having grave problems accessing the funding available for communication support in England. Some 30% of people with motor
	neurone disease will die within a year, and 95% will lose their voice. Will the Prime Minister meet the Motor Neurone Disease Association to sort out why these delays are happening in NHS England? Will he agree to fund communication support so that the association can provide it quickly and effectively while the NHS gets its act in order, so that no one dies without being able to communicate their last thoughts to their loved ones?

David Cameron: First, let me commend the hon. Lady and others across the House for the work they do on motor neurone disease. Anyone who has known someone who has suffered from that disease—as I have—realises that it is a most appalling, debilitating condition, which is very difficult for families to cope with. I will certainly look at the report the hon. Lady has produced and make sure that the proper meetings are held with the Department of Health, so we do everything we can to support these people and allow them, as she says, to communicate with their families up until the last moment.

Julian Huppert: It is now clear that the decision by the last Government to put Hinchingbrooke hospital out to tender, with the last three bids under that Government all being led by the private sector, was deeply flawed and has been a massive failure. Does the Prime Minister accept that this experiment in privatisation has failed and that the future of Hinchingbrooke hospital should be fully within a public NHS?

David Cameron: It is important that we make decisions based on what will be best for patients. My view is that there is a role for the independent sector within the NHS, but it has only gone from something like 5% of the total to 6% of the total. [Interruption.] It is no good Opposition Members shouting about privatisation: it was their decision to allow this hospital to be run by the private sector. Frankly, on a day when they are in complete confusion about their health policy, we have the shadow Health Secretary saying he opposes all of this but cannot say what percentage should be in the private sector; we have his deputy saying that they want to see more of the NHS in the private sector; we have the Leader of the Opposition refusing to confirm that his shadow Secretary of State has his full confidence—yet this is meant to be Labour’s great big election-winning idea. What a complete shambles!

Clive Efford: The Prime Minister, his Chancellor and the entire Conservative party like to talk about their “economic plan”. An independent report published yesterday by a group of academics—[Interruption.] I can wait. The report shows that welfare cuts contributed merely to cutting tax for higher earners and contributed nothing to reducing the deficit. It also shows that families with children under the age of five have been the hardest hit. What future is there for the country with an economic plan that steals from the poor and gives it to the rich?

David Cameron: It is the “long-term economic plan”, by the way.
	Let me tell the hon. Gentleman how things are going in his own constituency. Never mind the academics; let us see what is happening for working people in
	his constituency. The number of people claiming unemployment benefit is down by 31%, the youth claimant count is down by 34%, and the long-term youth claimant count is down by 57% in the last year alone. If we look across London, we can see 470,000 more people in work, and more than half a million private sector jobs have been created.
	What I want to know is this: when did the Labour party become the welfare party? When did that happen? It is Members on this side of the House who are standing up for hard-working people, and who are on the side of work and on the side of enterprise, reforming work and, yes, reforming welfare to make that happen.

Eric Ollerenshaw: As part of the Prime Minister’s long-term economic plan to rebalance the British economy, will he continue to support Britain’s coastal communities, such as Fleetwood in Lancashire, to make up for 13 years of neglect by the last Labour Government?

David Cameron: My hon. Friend is absolutely right about the importance of investing in our coastal communities, and that is what we have done through our coastal communities fund. So far more than 200 projects have benefited, creating or safeguarding more than 16,000 jobs. I know that Fleetwood received a boost from the fund last year, when Wyre council was given a grant to develop new tourist attractions, but I want to see more happen to help my hon. Friend’s constituents and to help our coastal communities, of which Fleetwood is such an important part.

Thomas Docherty: The Prime Minister will be aware of the remarkable work that is being done on the Clyde and at Rosyth dockyard to build the country’s new aircraft carriers, but, just as our country needs a new generation of aircraft carriers, Scotland needs a new generation of young skilled workers. Will the Prime Minister guarantee that he will use the procurement power of the Ministry of Defence to deliver real apprenticeship opportunities to young Scots?

David Cameron: Of course we will do that. Those who visit the aircraft carriers being built on the Clyde will see that an enormous amount is being invested in apprenticeship numbers, and that that investment is of huge benefit. Moreover, the carriers have not just benefited Scottish apprenticeships, because they have been built, in part, all over the United Kingdom. Let me also make this point: we can only afford to make these decisions because we have a long-term economic plan and a strong economy.

Richard Drax: I know that I do not need to remind the House that 453 members of our armed forces lost their lives in Afghanistan, and that many more were wounded, some seriously. Although we have brought home most of our troops, the 400 men and women of 2nd Battalion The Rifles are still serving in Kabul with great distinction in support of Government forces. Does my right hon. Friend agree that it is time that we recognised the efforts of all who served in that war with a commemorative event?

David Cameron: I very much agree with my hon. Friend.
	All British combat troops had left Afghanistan by the end of last year, fulfilling the commitment that I made nearly five years ago. On Monday my right hon. Friend the Defence Secretary welcomed to Parliament the final homecoming parade of our combat troops who had been deployed in Afghanistan, and I am pleased to announce today that on 13 March we will hold a special service of commemoration in St Paul’s cathedral and a military parade to mark the end of combat operations in Afghanistan.
	I believe that this is a fitting moment at which to pay tribute to the extraordinary contribution made by our armed forces in Afghanistan over 13 years. During that time, 453 lost their lives, and many more were injured. Their mission has helped to prevent Afghanistan from being used as a base from which to launch attacks on us here at home, and they have enabled Afghanistan to begin the task of looking after its own security in the years ahead. The whole House—indeed, the whole country—is right to be incredibly proud of our armed forces, and of all those who served in Afghanistan.

Jeremy Corbyn: Has the Prime Minister had a chance to place a call to Alexis Tsipras, the new Prime Minister of Greece, in order to congratulate him on winning the election, and also to learn from him why the people of Greece have finally said no to the imposition of the most appalling austerity, the destruction of their public services, high levels of unemployment, and deepening poverty? Will the Prime Minister use his good offices in the European Union to ensure that they are given the debt write-off they are so desperately seeking, so that Greece can be restored to the prosperity it deserves to enjoy?

David Cameron: I have had the privilege of speaking to the new Greek Prime Minister; indeed, I asked him what his long-term economic plan was. What I think is absolutely key to recognise is that over the last four years we have seen the British deficit come down, and we have seen jobs created and the economy bigger than it was before the crash, whereas in Greece they have had repeated economic failures, and we can hardly blame them for wanting to take a different approach. I hope good sense will prevail on all sides, and, as I said to the Greek Prime Minister, there are other areas where we can work together, not least because Britain has led the world on tax transparency and making sure companies pay the taxes that they should—something that needs to happen in Greece as well as the rest of the European Union.

Roger Williams: General practitioner recruitment is a problem nationally but particularly for rural practices. Many GP practices on both sides of the England-Wales border serve patients from both nations. What can the Government in Westminster do, through working constructively with the Welsh Government, to promote training and recruitment of GPs so these practices remain viable and sustainable?

David Cameron: One of the things we can do is share ideas with the Welsh Assembly Government. One thing we are pioneering here is making sure newly qualified doctors are offered special payments if they become GPs, and this is part of a £10 million plan we have to recruit even more. In England we have 1,000 more GPs working than we did back in 2010, and I hope the
	NHS in Wales will, while it is underfunded by the Labour Government in Wales, look at creative ideas like this.

Julie Hilling: StepChange has reported today that the average debt of Bolton residents is £11,000. Does this not show that my constituents are suffering because of the Prime Minister’s failure to deal with the cost of living crisis?

David Cameron: The hon. Lady’s constituents are benefiting from the fact that the economy is growing, our deficit is coming down and we are creating jobs, but we are dealing with the debt crisis which her Government put in place in our country. That is what is happening, but every day, the British economy and the British country is getting stronger; every day, the Labour party is getting weaker.

Andrew Jones: New figures show that, as a result of the focus on earlier diagnosis, increased access to treatments and the latest medicines, 12,000 more patients every year are now predicted to survive their cancer than just five years ago. Does the Prime Minister agree that while this is very encouraging, there is a long way to go and we have to maintain our focus on fighting cancer?

David Cameron: My hon. Friend is absolutely right. What we see in our country is a 50% increase in cancer referrals, which means we are identifying cancers earlier and treating them better, and we also have the Cancer Drugs Fund, which has helped 60,000 patients. We need to go on with these improvements, but we will only be able to do that if we have a strong economy backing our strong NHS.

NHS Major Incidents

Andy Burnham: (Urgent Question): To ask the Secretary of State for Health if he will make a statement on what guidance has been issued by NHS England on declaring a major incident.

Jeremy Hunt: As you know, Mr Speaker, I am always happy to come to the House to discuss the NHS, but today we have been brought here to discuss a local operational issue that, regrettably, the Opposition have tried to spin as part of their policy to “weaponise the NHS.”
	As I said to the House earlier this month, a major incident is part of the established escalation process for the NHS, and has been since 2005. It enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.
	The decision to declare a major incident is taken locally, and there is no national definition. We must trust the managers and clinicians in our local NHS to make these decisions and support them in doing so by ensuring that there is sufficient financial support available to help them to deal with additional pressures. The document that has been questioned this morning by the Opposition Health spokesman was issued by the local NHS in the west midlands. That was done to help its clinical commissioning groups to work with local NHS organisations to deal with the unprecedented pressures they have been facing this winter. The chief operating officer of NHS England, Dame Barbara Hakin, has said this morning that this was a local decision and neither the responsibility of Ministers nor the result of pressure by Ministers.
	Let me finish by praising the NHS for coping well with the unprecedented pressures. Performance against the A and E standard improved to 92.4% last week, which is testament to hard-working staff, and this Government will support them, not try to turn their efforts into a political football.

Andy Burnham: In the first week of January, at least 14 trusts across England declared major incidents, including three in the west midlands. Official figures show that pressure continued into the second and third weeks of January, with only seven A and Es out of 140 meeting the Government’s target. There were ambulance diverts, and even an A and E closure, but no further major incidents were declared. On 7 January, when the Health Secretary was called to the House to answer an urgent question, he said:
	“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]
	He has just repeated that now, and called this a “local operational issue”, but that does not appear to be entirely accurate. Let me quote from the guidance that was sent in the middle of January. It is headed “NHS England” and it states:
	“Major incidents should be agreed with…the Director on call for NHS England”.
	Will the Secretary of State now withdraw his earlier statement to the House and confirm that this decision is not purely local, in that it has to be approved by NHS England?
	Let me turn to the impact that this has had on trusts. There are 17 enhanced criteria set out, including requirements that may cause serious time delays for trusts in an emergency. For instance, there is a requirement on the on-call CCG manager to visit the trust and undertake a review. Let me tell the Secretary of State how those new rules were perceived by senior managers. I shall quote from an e-mail sent by the head of operations at one trust, who said that the requirement had been
	“introduced by NHS England to effectively stop trusts from calling a major incident…Our hands will be tied in most cases if they wish to call a major incident for capacity reasons”.
	Is the Secretary of State confident that the new enhanced criteria are not unduly burdensome and will not cause unnecessary delays for a trust in an emergency situation? Is he satisfied that this guidance is consistent with good practice at national level and safe to be left in place?
	The Secretary of State has used the word “local” many times today, and spoken of the only consideration being relieving pressure on hospitals facing severe demand. However, his claim that this matter is purely local is called into serious question right now by this 86-page document headed “NHS England”—[Interruption.] He says it is from the local team, but this is a regional function of the national body, NHS England. The local claim will not wash, I am afraid.
	I will tell the Secretary of State what the guidance tells trusts to take into account. He says that it concerns only operational matters, but section 7.2.3 is headed “Politics”, and subsection (a) asks:
	“Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?”
	Subsection (c) asks:
	“Is there a risk of reputational damage?”
	Does not this muddy the waters hugely? Will it not distract doctors whose sole focus should be on the emergency situation, and not on media and political considerations that should form no part of their judgment? If the Secretary of State agrees with me on that, will he today instruct NHS England to withdraw this guidance and issue more appropriate instructions to the NHS in the region? The NHS remains under serious pressure, and it needs the clearest of instructions based on what is best for patients. Will he act today, so as to leave the NHS in no doubt that that must be its paramount and only concern at all times?

Jeremy Hunt: In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.
	As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.
	Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

Sarah Wollaston: Our hard-working NHS staff and, more importantly, patients need to have absolute confidence that the Secretary of State will never lean on operational decision making in these circumstances and will always allow that decision making to take place at the appropriate local level, backed, if necessary, by national guidance.

Jeremy Hunt: My hon. Friend is absolutely right to say that. It is why many people in the NHS will be so astonished to hear the shadow Secretary of State, who presided over a culture where precisely that kind of leaning from on high happened, making it difficult for people to make those local operational decisions in the interests of patients, now trying to make a political point. This was a local decision and it was confirmed today that Ministers had no involvement in it, and Labour should stop trying to score political points.

Barbara Keeley: This Government caused confusion about decision making and accountability because of their reckless and expensive restructuring of the NHS. Now, to achieve what the Secretary of State wants to achieve, he has to resort to the sorts of measures we are discussing. We have had two major incidents declared in local hospitals in Salford in one week recently, and I have great concerns that this sort of guidance means that it is harder for clinicians to take the steps necessary to resolve the A and E crisis. They should not have to think about the issues listed in this document: politics and whether there is a risk of
	reputational damage. I do not want Salford Royal hospital and the Royal Bolton hospital thinking, “We can’t do this because of reputational damage.” This should be done entirely on the basis of clinicians’ reasoning.

Jeremy Hunt: That advice was issued in the west midlands, and not in Salford. The hon. Lady talked about the reorganisation. Well, that reorganisation means that we have been able to afford 82 more hospital doctors and 589 more nurses in her area, which is helping her constituents. Salford is one of the best examples of integrated care in the country, which is why any hospital declaring a major incident should think about the impact on the rest of the NHS locally. That is what the guidance says.

Peter Bone: The shadow Secretary of State is a very honourable gentleman, but he might live to regret this political football stuff. In north Northamptonshire, my hon. Friend the Member for Kettering (Mr Hollobone), the hon. Member for Corby (Andy Sawford) and I are working together on local decisions about our A and E. Surely that, and not political football, is the way forward.

Jeremy Hunt: My hon. Friend is absolutely right. I have spoken to the chief executive of Northamptonshire county council and I have heard about the excellent integration of services that is now starting to happen between the local authority and the local hospital. That is the way forward. The guidance simply says that trusts must pay attention to the impact on the local health economy before they make a local decision. It is time that Labour stopped playing politics with something that they know is a disgrace.

Grahame Morris: Is the Secretary of State satisfied that the new guidance with its 17 criteria, to which my right hon. Friend referred, will not have the effect of making it less likely that NHS hospital trusts in the west midlands or in my region declare an emergency plan?

Jeremy Hunt: Declaring a major incident is the decision of the local hospital trusts, and that is right. But it is important that, before they make that decision, they should take proper account of the impact on the rest of the local health economy. That is what every responsible hospital wants to happen, and that applies to the hon. Gentleman’s area as well as everywhere else.

Bernard Jenkin: Following the declaration of a major incident at the accident and emergency unit of Colchester hospital, we now await the Care Quality Commission report into that incident, which will be published very shortly. We want the report to tell the truth, but it is harder to tell the truth in a political atmosphere where there are people who want to gloat over these challenges to get votes.

Jeremy Hunt: My hon. Friend is absolutely right. I have spoken to the chief executive of the hospital, and I must say that she and her staff are doing a good job in turning around a very difficult situation. What they want is support. We have issued sensible guidance that tells hospitals that if they declare a major incident, they
	must take account of the impact on the rest of their local health economy. A responsible Opposition would support such guidance, and not to try to turn it into a political football.

Valerie Vaz: The Manor hospital had to declare a major incident due to inordinate pressure from the closure of Stafford A and E. That is not a local issue, but a national one. When will the Secretary of State provide the hospital with the extra money to absorb the closure of Stafford A and E?

Jeremy Hunt: I can reassure the hon. Lady that we have provided a huge amount of extra money to deal with the problems in the wake of what happened at the former Mid Staffs Trust. We are continuing to give every support we can to Walsall and Stoke and other trusts. We have more doctors and more nurses and major changes are happening. The problem in Mid Staffs went on for four long years, and we do not want to wait that time before sorting out the problems.

Paul Burstow: Clearly, patient safety must be paramount. We must ensure that any guidance supports the ambition that exists on both sides of this House for a more integrated system that takes into account the capacity across the whole service. Does the Secretary of State agree that what we also need is clarity and certainty over how the NHS and social care will be funded over the life of the next Parliament so that we realise the ambition and potential of the Care Act 2014 and we deliver Simon Stevens’s NHS plan?

Jeremy Hunt: I totally agree with the right hon. Gentleman. I am sure, too, that he will agree with me that the best way to give the NHS certainty over funding in the future and the increase in funding that it needs to implement the five-year forward view is a strong economy, and it is only this Government who are able to deliver that.

Gisela Stuart: According to some statistics, I have more medics per square mile in my constituency than any other MP. I also have the University Hospitals Birmingham NHS Foundation Trust on my patch and a lot of people who work across the west midlands and in Birmingham. The Secretary of State’s operational guidance, as he has interpreted it, is not perceived in the way that he thinks it is. A and E consultants tell me that they are not just overworked and overstretched, but unsafe. If he thinks the guidance is purely operational without any political interference, will he follow the call of the shadow Secretary of State and say that he will issue a new set of guidance that makes that clear, because it is not how it is seen on the ground?

Jeremy Hunt: I have great respect for the hon. Lady, so I hope she will understand this: when people are worried about political influence over operational guidance, I do not then issue some political guidance. The only thing that I, as Health Secretary, say in respect of instructions going out is that patient safety must always be the priority, and that is what I have said time after
	time. But then the actual decision about whether to declare a major incident must be taken by people locally. Julie Moore, the chief executive of UHB, is fantastic and absolutely able to make those decisions, and those decisions should not be second-guessed by politicians.

Sarah Newton: Does my right hon. Friend agree that it is really important to let NHS England’s local teams—in our case the Devon and Cornwall area team—make decisions with local leaders of hospitals? So many people in the north of Cornwall live closer to Derriford in Devon than they do to Treliske in my constituency. It is only right that NHS England staff closest to the clinicians make those decisions.

Jeremy Hunt: That is absolutely right, but Members on the two sides of the House hold different views. We believe in devolving power locally and we want local decision-making. We accept that that might mean that sometimes services are slightly different in one part of the country compared with another, but the benefit is that we do get that local knowledge. In the past few weeks, I have spoken to South Western ambulance service, which had particular pressures over Christmas, to ask whether there is anything we can do from the centre. What I want to ensure is that the decisions that keep my hon. Friend’s constituents safe are made locally, because they are likely to be better than any that I could make in Whitehall.

Stephen McCabe: The Secretary of State is very reassuring when he says that, under him, the NHS is free from political news management. If that is the case, why does he not free it from the constraints of election purdah, and allow these officials to get on with their jobs without having to second-guess the consequences of some of the decisions?

Jeremy Hunt: We are not in election purdah. The point is that during election purdah we will continue to publish the weekly A and E performances and other figures from the Office for National Statistics, and that has always been the system. But there is a difference between what is happening in the run-up to this election and what happened in the run-up to the previous election. This time, the CQC is free to speak up, without fear or favour, about the quality of care in every single hospital in this country, and it will continue to do so.

Marcus Jones: The Leader of the Opposition and the shadow Secretary of State visited the George Eliot hospital on Monday. The Leader of the Opposition praised the hospital for its progress under this Government. If we consider that, and then look at the way the Opposition come to this House and make political point scoring their No. 1 aim, we can see not only that they are hypocritical but that they want to put politics before patients.

Jeremy Hunt: I commend my hon. Friend for the support he gives to his local hospital. I visited it and did part of a shift in the A and E department. This was a hospital that, under the previous Government, had one of the highest mortality rates in the country. We introduced a new special measures regime and independent inspections. Labour tried to vote them down, but the result is that that hospital has come out of special measures, forged a
	strong new partnership with UHB and gone from strength to strength. Things are getting better because we are being honest about poor care, and did not sweep it under the carpet.

David Winnick: The Manor hospital in Walsall was one of the very first in the west midlands to have to declare a major incident—a level 4 incident. I visited the hospital and saw the number of people on trolleys waiting for more than four hours. I want to pay tribute to the dedicated staff at the hospital—medical and non-medical—for all that was done. But the Secretary of State should not minimise the situation that has occurred. He should recognise that it is a matter not of playing politics but of genuine concern for our constituents.

Jeremy Hunt: I entirely agree with the hon. Gentleman. He should be reassured that because of those real pressures, which I would never seek to minimise, we put in an extra £4.5 million of funding to his local area, paying for more doctors, more nurses, more community staff and more beds. As he says, we should congratulate the staff in that hospital on their work, and also recognise that, despite those pressures, they have made real progress in improving the quality of compassionate care for the patients in that hospital. They have been very well led by the chief executive, whom I have also met.

Robert Halfon: Last week, the hon. Member for Leicester West (Liz Kendall) came to Harlow and attempted to weaponise the local NHS and scare local residents. A day later an interview was published in which she said that she supported privatisation in the NHS. Does my right hon. Friend agree that the best way to help the Princess Alexandra hospital in Harlow deal with major incidents is to do what the Government are doing, with £5 million extra last year for our A and E, and £4 million extra to help the NHS this year?

Jeremy Hunt: Indeed, across the country we have put in £700 million, which has paid for 6,400 additional beds in the system. All of that is possible because we have a strong economy and we can put extra funding into the NHS. What those people in my hon. Friend’s hospital want most of all is support from Members in all parts of the House, and not to see their efforts turned into a political football.

Barry Sheerman: Does the Secretary of State agree that Calderdale and Huddersfield trust was, until 2010, one of the most successful trusts in the country? I have a letter embargoed, ironically until 1 pm today, telling me of serious financial problems—not a major incident—caused by the reforms that his Government have introduced in the NHS. I remind him that it is my job as a member of the Opposition to weaponise—to use as a weapon—the disgraceful policies that his Government have introduced that are destabilising and destroying the national health service in my town and constituency, and up and down the country. I am a member of the Opposition, I will use this as a political weapon, and I will do so until the election, which we will win.

Jeremy Hunt: I am afraid that the trouble is that there are just too many people on the Labour side who think exactly like that. I suggest that the hon. Gentleman go
	and talk to people working in Calderdale and Huddersfield NHS Foundation Trust and ask them whether they want him to use the NHS as a political weapon in that way. They have improved their performance over the past few years and are seeing more people within four hours—every year, 4,000 more people within four hours than when Labour was in office—and MRSA cases are down. There are 79 fewer clostridium difficile cases; 525 more people are treated for cancer every year; and there are 6,200 more operations every year. Those are real improvements making a real difference to his constituents. He should celebrate them, not try to run them down.

Henry Smith: East Surrey hospital, which is the A and E department that covers my constituency, not least because Labour closed Crawley hospital’s A and E in 2005, has not had a major incident. Can my right hon. Friend confirm that major incidents have decreased because of the extra investment that he has put into the NHS, in stark contrast to Labour-controlled Wales, which has cut the budget?

Jeremy Hunt: I have been to East Surrey hospital, which is a good example. It, too, has had its share of problems with care, but it has addressed them head on. Standards in the hospital are getting better, and it is encouraging to see that refreshing openness and honesty. We have put more investment into the NHS. Welsh patients are angry, because they can see that openness and transparency about results, combined with strong financial support, not cuts from central Government, lead to better service. Rather than try to create a political weapon in England, Labour should act where they can do something about it—in Wales.

Rosie Cooper: I was recently told by staff in Aintree hospital on Merseyside that, in the interests of patients and patient safety, executives should have declared a major incident. Although the execs teetered on the brink, they feared the political consequences of making that decision rather than doing the right thing. What genuine help and advice can the Secretary of State give execs who face that situation on the front line and help them to do the right thing for patients?

Jeremy Hunt: If executives did not declare a major incident because they were worried about the political consequences, they were wrong, but I would have to be persuaded that they would do that, because every NHS executive I speak to wants to put patients first, with patient safety paramount. On the practical things that we are doing, there are 60 more doctors, and 41 more nurses since 2010, and £4.5 million to help them through this winter. We are doing a lot of practical things to help the NHS in the hon. Lady’s area through the winter.

Andrew Stephenson: Many major incidents have their roots in things that happened some time ago. Blackburn’s A and E department has been struggling to cope with demand since Burnley’s A and E department was downgraded under Labour in 2007—a decision that the right hon. Member for Leigh (Andy Burnham) defended several times in the House, including on 19 November 2009, when he said:
	“‘This is saving lives; I will stand by it’”.—[Official Report, 19 November 2009; Vol. 501, c. 236.]
	On behalf of the residents of Pendle, I urge the Secretary of State to take no lessons from Labour on the management of our NHS.

Jeremy Hunt: That is it, and that is why it is not working for the Opposition politically when they try to put the NHS centre stage. They can see people who downgraded or closed 12 A and E departments across the country during their time in office now coming to Prime Minister’s questions and trying to criticise this Government when similar things have happened. The answer on all these occasions is to put patients first, do the right thing for patients, be honest about the problems and sort them out, and that is what the Government are doing.

Mike Gapes: The hard-working and dedicated staff at Barking, Havering and Redbridge trust, at King George hospital in my constituency and Queen’s hospital in Romford, know, because their trust is in special measures, that there has been a lot of reputational damage. On 5 January, elective operations were cancelled—in my personal case, at two hours’ notice; I was not the only constituent who had to go through that—because of A and E pressures in the trust. Can the Secretary of State explain whether hospitals in special measures have a special requirement so that they do not need to declare that they are in the position of hospitals that have made the decision to say that there is a major incident, or is it just coincidental that although operations were cancelled on a large scale on 5 January no major incident was declared at Barking, Havering and Redbridge?

Jeremy Hunt: I can confirm that there is no difference in any guidelines issued for hospitals in special measures and for hospitals not in special measures. This is a good example of a trust with deep, pronounced problems over many years. There was a terrible tragedy in 2007, I think, when someone gave birth sitting on a toilet seat. This Government have said that we are going to tackle those problems and put the trust into special measures. It has more doctors and nurses: 230 more hospital nurses in the past four years in that trust. We are making a real difference—we have a new management team—and I think that things are beginning to get better in that trust in a way that has not been the case for many years. I hope that the hon. Gentleman would welcome that.

Stephen Mosley: The shadow Secretary of State called on the Secretary of State to intervene to stop political interference in the NHS. May I ask my right hon. Friend to ignore such siren voices and rely instead on local doctors and local health professionals to make the best choices for our local NHS?

Jeremy Hunt: My hon. Friend eloquently points out the great irony in what we have heard from the Opposition Front Bench. We do not want an NHS in which every single operational decision is made from behind the Secretary of State’s desk. We want to trust people on the ground. Why do we want to do that?

Andy Burnham: Politics.

Jeremy Hunt: Exactly. We do not want politics to get in the way of what is right for patients, which is what happened when the right hon. Gentleman was Health Secretary. It will not happen while I am Health Secretary.

Mark Reckless: Do we have sufficient measures, short of declaring a major incident, to help to relieve hospitals such as Medway, where there has been an ongoing problem of excessive waiting times at A and E?

Jeremy Hunt: Yes, we have other measures in place. At every stage, trusts should do what is right for patients. Sometimes they declare an internal major incident, sometimes it is an external major incident, but what is important is that they take account of the impact on the rest of the local health economy. At Medway hospital, which the hon. Gentleman mentioned, things are getting better. It has been through a difficult period. We have been honest about the problems, we have given it a lot of external support, and I hope that the news will continue to get better.

Richard Drax: As we know, one cap does not fit all. That applies to the NHS as much as to anything else. In Dorset the clinical commissioning group is reviewing health services and looking for local solutions to local problems. Does my right hon. Friend agree that that is the long-term solution for the NHS, rather than politicians sticking their noses in where, frankly, they should not be?

Jeremy Hunt: I absolutely agree with that. What I will not do is go round the media and say that the problems that the NHS is facing in Dorset, as it faces everywhere, are due to the fact that the area is very rural, which is the excuse that we heard over the weekend from the shadow Health Secretary for the poor performance of the NHS in Wales. We want local solutions and the highest possible standards—what we can do is give guidance and funding from the centre and make sure that patients are always put first.

Jack Dromey: In his attempt to gag hospitals over the growing accident and emergency crisis, the Secretary of State has sanctioned guidance that “we must avoid reputational damage”. Whose reputation? His reputation? Does the right hon. Gentleman not accept that his reputation on the national health service is damaged beyond repair?

Jeremy Hunt: I will take no lessons in stamping out news stories on poor care because I am worried about the impact on reputation. That is what happened when the shadow Health Secretary was behind my desk, and it was totally unacceptable. That is why we had a clutch of hospitals where poor care was swept under the carpet year in, year out because a Labour Government did not want bad news to come out in the run-up to an election. It was a disgrace and this Government are putting it right.

Diana Johnson: Two weeks ago I asked the Secretary of State about a comment that had been made to me by a senior clinician
	in Hull that the trust in Hull at Hull royal infirmary had been on internal major incidents on and off since December. The Secretary of State told me that that was not really an issue and that it was down to the trust, but the documents that have been produced today show that the real reason is that it is politically much more expedient to have an internal incident than to declare one externally and get all the bad publicity and reputational risk mentioned in the document to which my right hon. Friend the shadow Secretary of State referred to. That is the case, is it not?

Jeremy Hunt: Let me make two points to the hon. Lady. When I talk to the House about the number of major incidents, we make no distinction between internal and external incidents. We talk about them all as major incidents. There is no benefit, if one looks at it in that way, to Ministers from it being either an internal or an external incident. What matters is the right thing for patients. Rather than trying to politicise the issue and turning it into a political football, the Opposition should listen to Dame Barbara Hakin, chief operating officer of the NHS, who said clearly today that the decision was nothing to do with Ministers, they did not know about it and it was not taken at the request of Ministers. Labour should concentrate on supporting the NHS where it could do with its help—in Wales today.

Chris Williamson: The Secretary of State singularly failed to answer the question from my hon. Friend the Member for Easington (Grahame M. Morris) when he asked whether it would be more or less likely that a major incident would be declared as a result of the new guidance. Clearly, if it is less likely,
	that is bound to have an impact on patient safety. Can the Secretary of State confirm whether this issue was raised in his meeting with NHS England on Monday?

Jeremy Hunt: It was not raised by NHS England on Monday because I did not know about this local guidance, as I had absolutely nothing to do with it.

Clive Efford: Can the Secretary of State explain why in the incident response plan from NHS England there is an entire paragraph headed “Politics” under the principles for considering an escalation response? In the House on 7 January he said:
	“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]
	However, the guidance issued in the middle of January says that major incidents
	“should be agreed...with the Director on call for NHS England”.
	If it is not political, the Secretary of State owes the House an explanation of NHS England’s involvement and the meaning of that paragraph.

Jeremy Hunt: The hon. Gentleman has quoted selectively; he has not quoted the whole guidance. If he looks at the whole guidance, he will see that it clearly states that a responsible trust, before it declares a major incident, which is its decision, must make sure that there is not going to be a negative impact on the rest of the economy, because patients must always come first. He is also not saying what Dame Barbara Hakin said this morning —that none of this guidance was anything to do with Ministers.

Points of Order

Marcus Jones: On a point of order, Mr Speaker. On Monday the Leader of the Opposition and the shadow Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), visited my constituency. I thank the shadow Secretary of State for Health for having the courtesy to inform my office about his visit, in line with parliamentary protocol. However, this is far from the position that the Leader of the Opposition seems to take, as it is his second visit to Nuneaton in this Parliament. On both occasions he has failed to notify the sitting Member of Parliament of his visit. Given the social media response to the Leader of the Opposition’s visit, I would welcome him to my constituency as many times as he can get there between now and 7 May, but—

Mr Speaker: Order. I am extremely grateful to the hon. Gentleman for his point of order. The nub of the matter is not to make some sort of political point. The nub of the matter is that he is complaining that the protocol has not been observed. If the protocol has not been observed, it should be. If it has been, well and good. That is the end of it.

Clive Efford: Further to that point of order, Mr Speaker. Members have visited my constituency and have not told me they were coming, but I have never been petty enough to bring the matter to the Floor of the House.

Mr Speaker: I am grateful to the hon. Gentleman. It is perfectly in order for the hon. Member for Nuneaton (Mr Jones) to raise a point of order, but it is much better if Members can resolve these matters among themselves, rather than taking up the valuable time of the House.

Private Rented Sector (Decent Homes Standard)

Motion for leave to bring in a Bill (Standing Order No. 23)

Laura Sandys: I beg to move,
	That leave be given to bring in a Bill to require private landlords to ensure that any property they let meets the requirements of the Decent Homes Standard; and for connected purposes.
	This Bill aims to expect all landlords to comply with the decent homes standard, which we already demand of council-owned and housing association properties. I find it strange that we demand high standards for those properties owned by local authorities and housing associations, yet we do not have the same standards for the homes that families rent from private landlords. Why the difference? We cannot continue distinguishing between tenure, ownership or lobby when setting the standards that we expect of the homes in which our families, our pensioners, our friends and family live.
	Why would we discriminate against some tenants merely on the basis of who owns that property, not who lives in that property? The requirements of the decent homes standard are not particularly onerous nor unreasonable. They are standards of decency. Properties must meet the current statutory minimum safety standard for housing. That is not exactly revolutionary. Properties must be in a reasonable state of repair. Is that an unreasonable expectation, particularly when the properties are occupied by families on low income, who lack the ability or finance to do their own repairs?
	Properties must have reasonably modern facilities and services. In some of the properties that I go into in my constituency, I am shocked to see that there are no cookers, only microwaves. That captures those families into having to buy expensive food, with a lack of choice and lack of resilience. We should not allow families to have to live with such facilities in private rented properties, when in many cases we, as the community and society, pay those landlords to house those tenants.
	Properties must provide a reasonable degree of thermal comfort—that is, efficient heating and effective insulation. Why should those who rent privately have any different level of comfort or, more importantly, have to pay double what council tenants pay for the same level of heat? It is a perverse situation that we set up elaborate Government schemes to get better energy efficiency when improvements to the standard of the housing itself would help those in greater fuel poverty. It is not the people who leak energy; it is homes that are badly insulated.
	I represent one of the poorest wards in the United Kingdom and I am passionate about housing as it is at the heart of many of the problems faced by my community. In one ward, 84% of accommodation is privately rented, which creates fundamental challenges. There are some good landlords and some bad landlords. Some make 14% return on their investment year on year off the back of housing benefit, and do not reinvest that into the properties. I am sure that many hon. Members have experienced properties where deprivation can be smelled before they get to the door. There is the smell of damp and the common parts show that the properties are not
	of a standard that we would consider fit to live in. There is a lack of proper ventilation and of care and attention, and they are unsafe for children or the elderly.
	Do we not think that everyone deserves a place of security that can be called home, even temporarily? Draughts can be felt driving through flats that are impossible to heat due to rotten windows. There is mould in the kitchens and wallpaper coming off the walls. These are unfit properties and they create a much greater turnover of tenants, undermining community cohesion, disrupting children’s education, breaking links with support services that are so important to many families, and eroding any sense of permanency that would allow families to put down roots.
	Furthermore, some of my elderly constituents find some landlords intimidating and will not make a case for repairs or better insulation. I am sure that many hon. Members have made representations on behalf of such people to landlords, if they can be found. Even councils are confused about the standards needed, with some landlords happy to test enforcement standards in court, and often playing what I call legal chicken with the council. Why are we putting up with all this displacement activity to try to establish decent homes for decent people when a clear standard would create a much more transparent and fair set of expectations on all sides?
	The housing crisis is a staple part of today’s political lexicon, but it is crucial to remember and to highlight that the housing crisis that we face is, for many, a qualitative one as well as a quantitative one. It is now time to start setting the standard for the tenant rather than on the basis of ownership. Let us look at the quality as well as the quantity of our nation’s housing, because all families, wherever they live, under whatever tenure, deserve decent homes.
	Question put and agreed to.
	Ordered,
	That Laura Sandys, Dr Julian Huppert, Mr Mark Prisk, Mr Stewart Jackson, Mr Andrew Love, Mark Pawsey, Bob Blackman, Mr Jim Cunningham, Mrs Cheryl Gillan, Caroline Lucas and Stephen Gilbert present the Bill.
	Laura Sandys accordingly presented the Bill.
	Bill read the First time; to be read a Second time on Friday 6 March, and to be printed (Bill 164).

Opposition Day
	 — 
	[15th Allotted Day]

NHS (Government Spending)

Christopher Leslie: I beg to move,
	That this House notes comments from leading doctors and nurses that the NHS is in crisis under this Government, which has wasted £3 billion on a reckless reorganisation; believes an extra £2.5 billion a year should be invested in the health service, including to fund an additional 20,000 nurses and 8,000 GPs, by raising additional revenue from closing tax loopholes, a levy on tobacco companies and a tax on properties worth over £2 million; further notes that the Office for Budget Responsibility has said that the Government’s spending plans in the Autumn Statement would return public spending to a share of national income last seen in the late 1930s, before there was an NHS, and a level which is incompatible with the Government’s claims to be able to protect the NHS; recognises that only four OECD countries have total government expenditure at 35 per cent or less of GDP and that all of these countries have significantly higher charging as a share of overall national health spending than in the UK; and calls on the Government to reconsider the plans set out in the Autumn Statement for even deeper spending cuts, which the head of the Institute for Fiscal Studies has said could involve a fundamental reimagining of the role of the state.
	We have discussed already today some of the issues facing the NHS, but when will the Government realise that our health service faces such unprecedented pressures that it is in intensive care and in need of urgent attention if we are to avoid reaching the point of no return?
	I want at the outset to set the context for this debate, because it is important that we look at this Administration’s record so far. We know that the numbers of people waiting for more than four hours in the accident and emergency departments of our hospitals throughout the country have grown and grown, but in 2014 almost 1.25 million people waited for longer than four hours. It is true that the number of people going to A and E has been increasing: in the last four years of the last Government, it was rising by about 60,000 a year, but in the last four years it has gone up by 600,000 a year. This is a rapid escalation in the level of strain on our NHS infrastructure, which has a series of causes that fall at the Government’s door.

Jim Cunningham: It gets worse. At University hospital in Coventry, we are now back to the bed-blocking of previous Tory Governments as a result of cuts to local government funding for social workers, which means that people cannot be discharged. That is back to the future, as it were.

Christopher Leslie: The accident and emergency situation is a barometer of a series of failures across the health and social care infrastructure. I shall certainly deal with some of those questions, as will my hon. Friends.

Simon Burns: Will the hon. Gentleman give way?

Christopher Leslie: I will give way to the right hon. Gentleman in a moment. My hon. Friend talked about Coventry; last Friday in my constituency in Nottingham I attended
	a summit with health chief executives, the local authority and others. At the A and E department at Queen’s medical centre more than one in four patients waited for more than four hours in the first few weeks in January—a totally unacceptable situation. This is not something that affects only my constituency; it affects those of all my hon. Friends, and probably even that of the right hon. Gentleman, whom I will be happy to give way to.

Simon Burns: I read the motion carefully. It is about the NHS and spending on it, as the hon. Gentleman has illustrated in his remarks so far. Will he explain something that puzzles me? I know that the shadow Secretary of State’s interview with Kirsty Wark on “Newsnight” last night was a car crash, but why is he not opening this debate? He has never been reticent in the past in coming forward to try to weaponise the NHS. Is it because his leader has wrapped him up in cotton wool to keep him away from the public gaze?

Christopher Leslie: The right hon. Gentleman raises a number of issues there. He has plenty to puzzle over, and he will always be a puzzled individual. The bigger question is where is the Secretary of State for Health when we are talking about these particular issues? [Hon. Members: “There!”] There he is. He is so anonymous he just did not make any impact on me whatever. I am delighted that he has walked in. He is quite unforgettable, isn’t he?
	The NHS has experienced problems not just in accident and emergency departments, as has been said, but across a series of services: missed cancer treatment targets for three successive quarters—15,000 people having to wait longer than the recommended 62 days to start their cancer treatment in the past year. It has not always been like this.

Charlie Elphicke: rose—

Christopher Leslie: The Government inherited a situation in which 98% of patients were seen in accident and emergency departments within four hours. While one in four patients is now waiting a week to see their GP, when Labour left office the vast majority were seen within 48 hours. In January, we know that 14 NHS trusts declared major incident status. [Interruption.] The urgent question today did not really provide the opportunity to clarify the exact words in the NHS England document, so I want to take this opportunity to do so on behalf of my right hon. Friend the shadow Secretary of State.

Charlie Elphicke: rose—

Mr Speaker: Order. Members shouting, and then expecting to intervene, do not display great wisdom. The hon. Gentleman can probably do better, and he should certainly try to do so, within the limits of his capacity.

Christopher Leslie: I am very grateful, Mr Speaker.
	In urgent questions, there is obviously a time limit on our ability to read out quotes from NHS England documents, but there is no such time limit in an Opposition day debate, so let us take the opportunity to spell something out clearly for the record. The Secretary of
	State is here now. I apologise for not noticing him as he came into the Chamber, but he is here now, and that is good, because I can hold this document up and show it to him—it says “NHS England” on the front. He is nodding; he has accepted that point. I turn to page 21, where in paragraph 7.2.3, under the heading—
	[
	Interruption.
	]
	Government Members want to shout me down. If the Under-Secretary of State, the hon. Member for Battersea (Jane Ellison), is patient I will read out the full quote from the NHS England document. It refers to principles for considering escalation and the responses to be had. Paragraph 7.2.3, under the heading “Politics”, says:
	“(a) Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?
	(b) Is there a requirement to bolster or assure public confidence?
	(c) Is there a risk of reputational damage?”
	I do not understand why an NHS document contains those exact words. The Secretary of State can probably read them from there, across the Table—he is nodding again. Yet only a few minutes ago he denied that NHS England had such a document. What am I holding up—a mythical piece of paper? We can now at least establish that NHS England has been issuing documents suggesting that reputational damage and politics need to be taken into account when preventing major incidents. We have now at least had the opportunity to read into the record, as Hansard will reflect, the full text of that NHS England document.
	This is the set of situations and circumstances that the NHS faces: pressures on A and E departments, pressures on cancer treatment, and pressures on the major incidents as we have seen. Why are things in such a fragile and critical state? The Government took £3 billion out of elderly social care and wasted it on a £3 billion reorganisation of the NHS that nobody voted for and nobody wanted. They are cutting corners and rushing the care that is needed to help the frail elderly to stay out of hospital. What greater example of a false economy could there be?

Marcus Jones: Given the hon. Gentleman’s comments about the adult social care budget and the Opposition’s complaints about the money that has been taken from local authorities, will he commit to giving the money that he says has been taken from local authorities back to them in the next Parliament, should we have the misfortune to have a Labour Government?

Christopher Leslie: That was a very helpful intervention. I thank the hon. Gentleman, who has only a number of months to go in his current job. We have explained how we can hire a further 5,000 home care workers, a further 3,000 midwives, a further 20,000 nurses and a further 8,000 GPs through the time to care fund—the £2.5 billion a year that is fully costed and fully funded. I will methodically go through the detail of how we pay for that—he need not worry about that.

Stella Creasy: Let us take this debate back to the people we care about most—the patients, such as the mum who got in touch with me today who had rung her local GP 28 times to try to get through to get an appointment for her daughter, and whose friend had been told, “Don’t risk it—go to A and E because we simply cannot see our doctors.”
	Does my hon. Friend agree that the fragmentation of the NHS has made it much harder to hold to account our local health care services such as the Royal Free trust?

Christopher Leslie: I am glad that my hon. Friend mentions the situation with GP numbers, which is another factor in the NHS infrastructure being under such pressure.
	Let us look at what has been happening with GP numbers, which are not keeping up with demand in the rising population. In 2009, there were 62 GPs for every 100,000 people; that has now fallen to 59 and a half GPs per 100,000 people. We have also seen cuts to GP training. It is no wonder that the Government ditched the 48-hour guarantee for people to be able to see a GP.

Charlie Elphicke: rose—

Christopher Leslie: I will give way to the hon. Gentleman if he can explain why the Government dropped the pledge that patients, including his constituents in Dover, should be able to see their GP within 48 hours.

Charlie Elphicke: Can the hon. Gentleman explain why he, rather than the shadow Health Secretary, is leading this debate? Is it because the shadow Health Secretary is reported to be clinging to his job, without any guarantees from the Leader of the Opposition?

Christopher Leslie: There you have it, Madam Deputy Speaker. Government Members are not concerned in any way about the state of the NHS or about GPs, but only about asking questions about procedure and process. I am here today because the shadow Treasury team, like every shadow departmental team on the Labour Front Bench, is committed to supporting our NHS and to making sure that we get the investment that is needed.
	Why is the situation so fragile? The Government scrapped NHS Direct and fragmented it into 46 separate, cut-price 111 contracts, which does not ensure that 60% of calls are dealt with by medical staff. That figure is now down to 20%. It is no wonder patients are so quickly being driven back to—[Interruption.]

Dawn Primarolo: Order. Minister, I heard what you said to your Back Benchers and it is out of order. The hon. Member for Wyre Forest (Mark Garnier) will disregard the advice from the Minister. I will not embarrass the Minister by saying exactly what it was, but I will not hear him say it again.

Christopher Leslie: That is rather curious, Madam Deputy Speaker. I would be quite interested to know what the Minister was saying. Perhaps the hon. Member for Wyre Forest (Mark Garnier) heard it. What did the Minister say to him?

Mark Garnier: I have to confess that I did not hear it—I do apologise—but it would have been very sound advice.
	I am curious. As we have a shadow Treasury Minister here, perhaps this is an opportunity for him to explain to my constituents what he proposes to do to help them. It is important to remember that one of the very first things the Labour Government did when they came
	to power was to close the A and E department at Kidderminster hospital and downscale that hospital. As a result, Labour policies were so massively hated by my constituents that they voted in an Independent, Dr Richard Taylor. That demonstrated just how unpopular Labour’s NHS policies really are.

Christopher Leslie: Labour Members are absolutely committed to saving the national health service from the fate that would befall it should the hon. Gentleman’s party have a further five years in office. We will absolutely not apologise for fighting tooth and nail to do what we can about, for instance, the staffing crisis that the NHS also faces.

Sarah Wollaston: rose—

Christopher Leslie: Before I give way to the hon. Lady, I shall tell her what is happening with staffing in the NHS. The NHS is now spending a further £500 million a year on agency nurses. Six thousand nurses who were trained in the UK have left the country and gone elsewhere, and 4,000 nurses are coming from overseas to try to back-fill some of those places. We are spending a fortune, day after day—far more than we ought to be—on these more expensive agency nursing staff. I know that as Chair of the Health Committee, the hon. Lady has a view on agency nursing within the NHS. Is she really content with the situation?

Sarah Wollaston: I will write to the hon. Gentleman on that point, which is very important, but I wanted to respond to his question to my hon. Friend the Member for Dover (Charlie Elphicke) about why we dropped Labour’s policy of 48-hour access. I will tell him why, as a former GP who was there at the time: it was because patients could not get advance appointments. It caused enormous distortion of clinical priorities, and it was absolutely right that it was dropped, as called for by the profession. It was a ridiculous policy and it is absolutely right that it has been dropped.

Christopher Leslie: The hon. Lady should know that there were provisions for advance appointments in the system that we had. Given that we have these pressures, with GPs being totally overstretched and having more and more people to deal with, and the shrinking number of GPs per head of population, she should not be surprised that we are in this situation. We have to do more to recruit and train more GPs. That is part of the way in which we would save the NHS from the situation that it is facing.
	When all these different factors are combined with the high levels of winter flu and the growing population, we have an NHS in crisis—but there is an alternative. Yes, we have to repeal the competition-driven Tory changes, but we also have to deliver a sustained increase in resources and a fund designed urgently to alleviate the pressures. That is why, as shadow Chief Secretary, I want to take the time to talk about our £2.5 billion fund.

Tim Loughton: I am grateful to the shadow Chief Secretary, because I have sat quietly and listened to 16 minutes of his speech trashing the NHS. Will he take the opportunity to
	congratulate staff at Worthing hospital who, in very difficult circumstances, have met waiting times targets in above 98% of cases? Will he congratulate the staff who have cut hospital-acquired infections by 50% since 2010? Will he congratulate NHS staff who have reduced the number of people in mixed-sex wards from 11,802 in 2010 to 170? May we hear some good news about the staff who are doing a really good job?

Christopher Leslie: We will hear this time and again from the Conservatives. They want to gag us when we dare to criticise their record on the NHS. We are not going to be quiet about it. We are going to fight for the future of the NHS. I would tell the hon. Gentleman that we do not have any criticisms of the staff in the NHS, or even of the managers who are trying their best in very difficult circumstances to keep the NHS on an even keel. He should know about the BUPA contracts in his West Sussex hospital—

Tim Loughton: indicated assent.

Christopher Leslie: The hon. Gentleman nods. Those contracts have greatly destabilised his local hospital. He voted for that in the then Health and Social Care Bill, which was designed to drive competition all the way through the NHS by stealth, and what a mess it has created in his own patch. I am happy to give way to him if he wants to apologise to patients in West Sussex for the waste and distraction the BUPA contractual arrangement has caused there. Will he apologise?

Tim Loughton: I am delighted to intervene because the shadow Secretary of State, who has now appeared, mentioned that in his car crash interview last night. I do not know if the shadow Chief Secretary has been to Worthing or has looked at the contract, but it made no difference in money terms. As it happens, I opposed the contract, as did my hon. Friend the Member for Worthing West (Sir Peter Bottomley), because there was no impact study. As a result, we will now get a better service—run by the hospital—that is more seamless for patients. Will the shadow Chief Secretary apologise?

Dawn Primarolo: Order. Interventions must be brief. Mr Leslie, get back to your speech.

Christopher Leslie: I think we got the gist of the intervention. The hon. Member for East Worthing and Shoreham (Tim Loughton) opposed such competition, but I think he voted for it in the Health and Social Care Bill. He has his own demons to worry about on that.

Grahame Morris: I, too, served on the Health and Social Care Bill Committee. Does my hon. Friend agree that one of the great problems we face with work force planning, as Government Members have highlighted, is that private sector providers by and large are not training the doctors and the range of staff we need to deliver an integrated health service?

Christopher Leslie: My hon. Friend is right. That is the crucial difference between those on the two sides of the Chamber: Government Members are not interested in
	having private or voluntary sector supplements where there is need in the NHS; their agenda is to replace provision across the NHS and to contract out across the board.

Several hon. Members: rose—

Christopher Leslie: If my hon. Friends will allow me, I want to make a little progress, but I will certainly give way again in a moment.
	As a member of the shadow Treasury team, I want meticulously to explain the alternative course by which we will deal with the requirement for 20,000 additional nurses and 8,000 additional GPs, and the time to care fund of £2.5 billion. First, we would raise £1.2 billion from the levy on ultra-high-value properties—those worth more than £2 million—the so-called mansion tax.
	Secondly, we would raise least £1.15 billion by closing three tax loopholes. The first is that hedge funds are avoiding stamp duty by getting tax-exempt investment banks to buy shares for them. At least £500 million is lost through that tax loophole, and we must close it. The second is that many large corporations, including some of the water utilities, are shifting profits out of the UK by borrowing large sums at high interest rates via their owners’ subsidiary companies through offshore stock exchanges. That is known as the quoted eurobond exemption. The third is that many employment agencies sign up workers to umbrella companies almost at random, and exploit tax reliefs on travel and subsistence without passing them on to the work force. Between £300 million and £600 million is lost to the Exchequer in that way. Those three tax loopholes must be closed.
	Thirdly, we need to take £150 million a year from a new levy on tobacco company profits. That levy has worked in the United States, and we believe it is now appropriate in this country.
	The sum of £2.5 billion is a significant investment that our NHS needs. It will also provide the time to care for the patients who deserve much more than the 15-minute chunks they have been getting recently.

Margot James: Leaving aside the fact that the previous Government were not much good at closing tax loopholes, I am sorry to hear that the Labour party has lost faith with one of the fundamental principles of the NHS, which is that it should be based on need and funded through general taxation. That is the most stable basis for funding our NHS, and the Labour party is taking a great risk with NHS finances by proposing otherwise.

Christopher Leslie: That is rather interesting. The hon. Lady would criticise us if we said that we would do this through general taxation, but when we show where the money will come from—pound for pound—she criticises that as well. I want to hear the Conservatives say where they will get the extra money from for the NHS. I will come to that in a moment, but I will first give way to my hon. Friend.

Lilian Greenwood: A moment ago, my hon. Friend was talking about the risks of privatisation. I know he shares my concerns about health services in Nottingham. What advice does he
	have for the voters of Nottingham who, as a result of the outsourcing of our hospital’s world-renowned dermatology department, which was then broken up, can no longer access acute dermatology services locally? How should our constituents vote on 7 May?
	[
	Interruption.
	]

Dawn Primarolo: Order. Mr Garnier, I am not going to tell you again. You are on a warning now. You make lots of interventions. Members show you respect, and I expect you to show it to others when they make their points.

Christopher Leslie: That is so unlike the hon. Member for Wyre Forest (Mark Garnier), and very out of character.
	My hon. Friend the Member for Nottingham South (Lilian Greenwood) is a doughty fighter for NHS patients in our city of Nottingham. She knows very well that we have been trying our best, in working with local trusts, to press them to ensure that such services are safeguarded. Ultimately, when our constituents see the Government passing legislation encouraging trusts to move a private income level of 2% to potentially 49%, and when they see the pressure trusts are under, they are not surprised that many such problems are occurring in our area. It is only through making sure that we find resources and channel them towards investment for the care needs in our NHS that we will deal with those pressures.

Andy Sawford: Does my hon. Friend agree that, as well as ensuring there are finances at national level, we must ensure they are fairly distributed across the country? NHS England has a target funding allocation for Corby, but the National Audit Office and the Public Accounts Committee say that my local health authority is the worst funded in the country. Will shadow Ministers commit to fairness of funding when in government?

Christopher Leslie: We know that the Conservative party has tried to distort funding formulas across the country by stealth. In fact, they have not done it stealthily; it has been pretty bleeding obvious. Given how local government funding formulas have been skewed—away from areas of need, and in a gerrymandering fashion—I certainly agree that such a situation must be reviewed.

Several hon. Members: rose—

Christopher Leslie: If my hon. Friends will allow me, I will give way in a moment. I want to pick up the point made by the hon. Member for Stourbridge (Margot James), when she implied that the Conservative party somehow has plans to support additional investment in the NHS. The Chancellor of the Exchequer alluded to the fact that the Government might be able to cobble together £2 billion of additional funding. According to page 65 of the Treasury Green Book—“Autumn Statement 2014”— £1.2 billion was supposed to come from reserves or underspends for the NHS, but there is absolutely no commitment for any additional money beyond 2015-16. I will give way to the Minister if he will explain where his party has identified resources to meet that commitment beyond 2015-16. Will he spell that out? [Interruption.] I do not think that he wants to. My hon. Friends will ensure that he explains later, as he has just promised, because the public need to know where the money will come from to meet the pressures we face.
	The Conservatives also wanted to switch £750 million out of Public Health England and Health Education England as some kind of sticking plaster for the NHS. However, we must think about the impact switching money away from preventive systems such as inoculations and vaccinations would have. [Interruption.] The Liberal Democrat Minister of State thinks that that is a good idea, but it is not a sustainable way to provide funding for our NHS. He has to do his sums again, make tough decisions and find the additional resources. Of course, the Liberal Democrats have said that growth will somehow magic up the money for the NHS, which shows their lack of credibility.
	It is no wonder that the Institute for Fiscal Studies has said that Labour is the most cautious party in ensuring that it fully funds its pledges. It is no wonder that the Government parties do not want the Office for Budget Responsibility to go anywhere near the costings for the promises of political parties.

Caroline Lucas: Does the hon. Gentleman agree that when Government Members ask us to congratulate NHS staff, which we do, it seems a bit hollow when they will not even pay nurses a decent wage? Does he further agree that privatisation is fragmenting the NHS, making it much harder to deliver a good service for patients?

Christopher Leslie: We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.
	I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to the hon. Member for Daventry (Chris Heaton-Harris) that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.
	That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.
	Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.
	The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.

Daniel Poulter: I am sure that the hon. Gentleman can be patient. I will reply to him in a few moments when he finishes his speech.

Christopher Leslie: It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.
	What else can we expect from the Conservatives? More privatisation and more market-based changes.

Barbara Keeley: I, too, serve on the Health Committee. Alongside the things that we have heard about today and the concerns expressed by Opposition Members following the Health and Social Care Act 2012, is it not a really worrying development that £1.2 billion of cancer services and end-of-life care services in Staffordshire and Stoke— a wide geographical area—are being tendered out in a 10-year contract? That is a risky thing to do and it has never been done before for a single disease. Will all patients with cancer who are at the end of their lives be able to rely on those services, given that the majority of those tendering are private companies? Is that not the big issue? Will the Minister answer that point?

Christopher Leslie: That is the sort of ideological stain that has pervaded the NHS policies of recent years. We must recognise that, should the Conservatives win the general election, we will see more of the same. That is the course the NHS will pursue. Not just that, but the Government breach the NHS constitution time and again on safeguards, waiting times, ambulance responses and cancelled operations. The squeeze on resources will force patients increasingly to pay for private treatment.
	It fell to the generation after the second world war to build the NHS. It fell to Labour in 1997, after 18 years of Conservative neglect, to save the NHS. Today, it once more falls to Labour to rescue the NHS and rebuild it for the 21st century. The choice is stark: a tangible and fully funded 10-year plan to boost investment in our
	NHS with Labour, versus more decline and more of the same from the Tories, as they dismantle the NHS by stealth. It is beyond doubt that the NHS as we know it cannot survive another five years under the Tories, because once the NHS is gone, we will never get it back.

Daniel Poulter: I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.
	It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.
	As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.

Grahame Morris: May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?

Daniel Poulter: To take the intervention in the spirit in which it was intended, I recognise that the hon. Gentleman is committed to our NHS, as are Members on this side of the House. That commitment to and investment in the NHS has been made clear by the fact that we have increased NHS spending by £12.7 billion during this Parliament.
	Opposition Members have also incorrectly asserted that our long-term economic plan is taking Britain back to the 1930s, but the latest forecast from the independent Office for Budget Responsibility shows that our plans would reduce total Government spending as a share of GDP from some 40% today to 35.2% by the end of the next Parliament in 2020—the same levels of public spending as were proposed under Labour in 2002, when the right hon. Members for Doncaster North (Edward Miliband) and for Morley and Outwood (Ed Balls) were in the Treasury. If it was appropriate to set public spending at that level under Labour when they were in government, they need to explain why it is somehow wrong for a Conservative-led or coalition Government to plan for a similar level of public expenditure in the future—something that the Labour party has completely failed to do to date.

Rosie Cooper: The Minister referred to the goodbye note from my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne). Would the Minister’s goodbye note say, “Good luck, there’s no NHS”?

Daniel Poulter: Such drivel, frankly, is beneath the hon. Lady. We have made considerable additional investment in the NHS. Comparisons between an NHS run by a coalition Government in England and the NHS in Wales bear up very well for the NHS in England.

Caroline Lucas: Just before I came into this debate I met a 10-year-old constituent, Margot, and her mother, who works for the NHS. She works all hours and still struggles to put enough food on the table. Can the Minister explain why the Prime Minister does not care about NHS workers? That is what Margot wants to know and that is what the rest of the country wants to know.

Daniel Poulter: I am familiar with the hon. Lady’s constituency, having worked as a doctor at a hospital in the area. Her question is very disingenuous when we have increased the number of front-line clinical staff working in our NHS, investing in more staff to treat patients. We have also recently agreed with the unions a pay deal that will see the majority of NHS staff receiving a substantial increase in pay, thanks largely to their increments. Other staff will receive 1%.

Mark Spencer: The Opposition appear to struggle with the concept that we can fund public services only if the economy is moving forward. The interest alone on the debts that the previous Government amassed would have been enough to build a hospital ward every 30 minutes.

Daniel Poulter: My hon. Friend makes a very good point. On this side of the House we believe that when we spend public money we should do so efficiently and effectively. We have also made Government spending
	much more efficient—
	[
	Interruption.
	]
	Rather than heckling, the hon. Member for Liverpool, Wavertree (Luciana Berger) might do well to listen to what I am about to say, because efficient public spending should be a priority for any Government, although it certainly was not for the previous Government. Cabinet Office figures, endorsed by the National Audit Office, show that £14.3 billion of savings, relative to 2009-10, have been made across many areas of expenditure, including procurement, work force, major projects and transformation. That is £850 for every working household saved by this Government, and clearly shows that we are spending public money much more efficiently and wisely than Labour ever did when in office.

Stephen Gilbert: Does the Minister agree that money can be spent only once? Labours say it wants to invest £2.5 billion from the mansion tax in the NHS, but it has already promised that to deficit reduction and introducing a 10p tax rate. That is nonsense.

Daniel Poulter: My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.

Christopher Leslie: The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?

Daniel Poulter: That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.
	The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.

Christopher Leslie: To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I
	am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?

Daniel Poulter: The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.
	As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.

Andy Burnham: I am grateful to the Minister, because I was going to mention my last year in office. Would he care to inform the House what the bill for management consultancy in the NHS was in 2010 and what it is now?

Daniel Poulter: I have just told the right hon. Gentleman very clearly that the cost of NHS managers doubled under the previous Labour Government, a profligate record of spending that has taken money away from front-line patient care.

Stephen Gilbert: The Minister missed one thing from the list. A written parliamentary question revealed to me in 2010 that the Labour party spent £250 million paying private providers to do precisely nothing.

Daniel Poulter: My hon. Friend makes a very important point. We could stand here all day talking about the inefficiencies and profligacy in running the NHS finances by the previous Labour Government. He is also right to highlight—

Andy Burnham: Will the Minister give way?

Daniel Poulter: I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and
	Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.
	If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.

Charlie Elphicke: Will my hon. Friend give way?

Daniel Poulter: I will give way one more time, but I do need to make some progress.

Charlie Elphicke: I am sure the Minister would agree that the shadow Health Secretary could have opened this debate, rather than trying to intervene now in a desperate way. Does my hon. Friend also recall the shadow Secretary of State, when he was Health Secretary in 2009, saying that we can
	“move beyond the polarising debates of the last decade over private or public sector provision”?
	That is what he said then. What does he say these days?

Daniel Poulter: My hon. Friend is absolutely right. The fact that the shadow Health Secretary’s colleague, the hon. Member for Nottingham East, opened the debate perhaps shows a lack of confidence. The shadow Health Secretary’s record is very difficult to defend.

Andy Burnham: Will the Minister give way?

Daniel Poulter: If the right hon. Gentleman wanted to contribute to the debate in such a meaningful way, why did he not have the courage to stand here and speak in this debate? I have been very generous in giving way. I know he does not like to be reminded of his record in office. Frankly, on NHS finances his record is abysmal, just like the previous Labour Government’s record of running our economy. If he wants to contribute he should speak in the debate. I will give way generously again later, but I want to make some progress.
	On the Government Benches, we know that we cannot have a strong NHS without a strong economy. In spite of the profoundly challenging financial position we inherited from Labour, I am proud that this Government have increased NHS funding in each year of this Parliament. As a result of the additional funding announced in the autumn statement for 2015-16, funding will be £16 billion higher in cash terms in 2015-16 than it was in 2010-11. That equates to an increase of £6.8 billion in real terms for our national health service under this Government.
	Our NHS is also on track to deliver up to £20 billion of efficiency savings this Parliament, having reported about £15 billion of efficiencies in the first three years. All of that has, or will be, reinvested into front-line patient care. Our commitment to our NHS has meant that, since the last election in 2010, there are now more than 17,200 more professionally qualified clinical staff, including over 9,000 more doctors, enabling 850,000 more people to have operations than 2010, and over 3,300 more nurses, midwives and health visitors. Fewer patients are waiting to start treatment, and hospital infections have virtually halved. Mixed-sex wards, a great scandal of the previous Government, have largely become a thing of the past. I could, and will, go on in a moment.

Alison Seabeck: The Minister talks about more nurses. Derriford hospital in Plymouth has had to fill more than 60 vacancies with nurses from overseas. Morale is so low among nurses in the UK—plus we are not training them—it cannot fill those vacancies. He spoke earlier about a substantial pay rise. Would he like to explain to the nurses in my constituency exactly how substantial that pay rise is, because they do not think they have had a substantial pay rise?

Daniel Poulter: Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.

Barbara Keeley: Will the Minister give way?

Daniel Poulter: I am going to make some progress and I am sure I will give way to the hon. Lady later on.
	The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.

James Morris: While we are talking about future resources for the NHS, may I commend the Government for what they have done to move towards parity of esteem in mental health and investment in talking therapies? Is it not important, when we consider future NHS resources, to
	consider the balance of the £14 billion that we currently spend on mental health services and how we can further invest in mental health services over the next Parliament?

Daniel Poulter: My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.

Luciana Berger: It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?

Daniel Poulter: Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.
	We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.
	At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.
	The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.

Christopher Leslie: Because I’m a doctor.

Daniel Poulter: Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.
	In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.

Barbara Keeley: rose—

Daniel Poulter: I will give way one more time, but after that I will not give way for a while, as I want to make some progress.

Barbara Keeley: I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.

Chris Heaton-Harris: Point to them.

Barbara Keeley: I am pointing at myself.

Dawn Primarolo: Order. Mr Heaton-Harris, will you allow the intervention to take place? I am sure you will have a chance to join the debate when you catch my eye later. However, I do not want interventions to be overlong either, because we do not have much time left in the debate. Barbara Keeley, will you therefore please be brief?

Barbara Keeley: Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?

Daniel Poulter: As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care,
	which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.
	Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.
	It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.
	Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.

John Woodcock: Will the Minister give way?

Daniel Poulter: I have been very generous in giving way, but I must now make some progress.

John Woodcock: rose—

Daniel Poulter: No, on this occasion, the hon. Gentleman will have to forgive me.
	Our capital investment in maternity services, which, as I said, is the biggest for decades, is making a big difference to mums, dads and new families. Thanks to our investment in the midwifery work force, we now have the highest ever number of midwives working in our NHS—about 2,000 more than in 2010—providing more personalised care and support for women and new mums. However, we must all recognise the challenges facing our health and care system in the months and years ahead. NHS England’s “Five Year Forward View” argued that we needed to do more to tackle the root causes of ill health through a radical upgrade in prevention
	and public health; to give patients more control over their own care, including through the option of combining health and social care, and new support for carers and volunteers; to ensure the NHS changes to meet the needs of a population that lives longer; and to develop and deliver new models of care, local flexibility and more investment in our work force, technology and innovation, some of which I have already outlined.
	That is why the Government have provided additional funding for NHS front-line services in 2015-16, including £200 million to pilot new care models and £250 million for the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities to support our GPs and primary and community care work force in the important work they do. In community care, we are committed to undoing the terrible mistake that was Labour’s 2004 GP contract, which left so many people, particularly the frail elderly, without the GP care they needed at evenings and weekends. Our investment will support GPs to provide care for patients seven days a week so that patients will once more be properly supported during evenings and weekends. We are also training an extra 5,000 GPs, in addition to the 5,000 extra we have already seen under this Government, to provide that care.
	We are clear, however, that if the NHS is to meet the challenge of increasing patient demand and expectations, it cannot stand still. By 2018, 3 million people in our country will have three or more long-term conditions, so we must continually adapt and change how we deliver care to support patients, families and carers, and deliver more care in people’s homes and communities. For our part, and as part of our plan for our NHS, not only are we delivering a strong economy so that we can protect our NHS budget, but we will continue to be ruthless in delivering greater efficiencies in estate management and procurement and in reducing back-office costs so that we can reinvest that money in front-line patient care. Furthermore, we will continue to back front-line staff with the training, equipment and new technology they need to do their job and provide high-quality patient care, which is why we have already made available an additional £2 billion down payment to deliver NHS England’s “Five Year Forward View” and why the Prime Minister has committed to continuing to protect our NHS and ensuring that it has the additional money it needs to deliver first-class patient care in the months and years ahead.
	In conclusion, I would like to thank the dedicated NHS staff working incredibly hard to keep us well looked after and safe in this busy winter period. As a practising doctor—I know Labour does not like it, given its dearth of real-life experience and the number of former special advisers on its Front Bench—I know how hard our NHS staff work and how dedicated they are to delivering the highest-quality patient care. I remind the House that we have been able to increase the money available to our NHS only because we have the growing economy to pay for it; because our long-term economic plan is working; and because, under this Conservative-led Government, there are more people in work than there were under Labour. Anybody who does not have an economic plan for the economy—and Labour has no plan for our economy, as has certainly been clear in today’s debate—does not have a plan for the future of
	our NHS. Through economic policies and by creating growth and jobs, we have been able to announce additional NHS funding for 2015-16 without having to raise taxes, including on people’s homes, as Labour would like to. This gives our NHS the funding it needs to begin implementing the plan set out in NHS England’s “Five Year Forward View”, so that it can continue to be a world-class, sustainable health service, delivered free at the point of need.
	When we came into power, we took two big strategic decisions with our NHS: to increase funding and to cut bureaucracy and waste, and to reinvest that money in more doctors, nurses and front-line staff and to improve front-line patient care. That is exactly what we have done, so the choice on 7 May will be clear: between a Labour party that bankrupted Britain and would do so again, at the same time bankrupting our NHS, and a Conservative Government, committed to securing our NHS by delivering a strong, stable and growing economy.

Lindsay Hoyle: I remind Members that there is a seven-minute speaking limit. We should get everybody in, unless there are interventions, in which case we may have to change it.

Emily Thornberry: Let me begin by thanking the Minister for his contribution today—particularly as he is a doctor. I also thank him for helping those of us with our Tory NHS debate bingo cards to show that he has used all the words we were expecting—“weaponise”, “Wales”, “long-term economic plan”—and for the additional benefit of sharing his understanding of the international banking crash, which is that it was Mr Brown shovelling money out of the back windows at Lehman Brothers that caused the entire world economy to crash.
	Let me move on to perhaps a much more important point. How are we going to fund the national health service in the future? What the Minister did not address—which is a grave disappointment—were some of the matters in the motion that we are supposed to be debating. My constituents prioritise the NHS probably over everything else. For them, it is all about our working together as one community and looking after everyone: no one is more important than anyone else; we all stick together; we pay our taxes and support the weakest; and all of us should be able to get world-class health care. We are very proud of the national health service, which has delivered that. However, my constituents are profoundly concerned about what is going to happen in the future. Can the national health service survive another five years of a Tory Government? The answer they come to very rapidly is no.
	The question is a simple one. How can the Prime Minister stand up at the Tory party conference and say, “We’re going to make £7 billion worth of tax cuts,” and not tell us where the money is coming from? How can the Prime Minister or the Chancellor of the Exchequer say that state spending is going to decline to the level it was in the 1930s, when in the 1930s we did not have a national health service? How does that work? How do we square that circle? Without answers to profoundly important questions such as those, the public simply say, “We don’t trust you with the most precious thing we have as part of our British identity. We want to be able
	to have a national health service that will hold us together.” How can the NHS be safe in the hands of this Government?

Daniel Poulter: rose—

Emily Thornberry: I give way to the doctor.

Daniel Poulter: The hon. Lady will of course be aware that our plans for public spending will only put it back to the level it was in 2002, under the previous Labour Government, which is hardly the bleak picture she paints. At the same time, we will be able to invest money in our NHS.

Emily Thornberry: I still do not understand why, therefore, the Office for Budget Responsibility says that the percentage of state spending will be at the level it was in the 1930s. In the end, although the Minister is a doctor, I would prefer to take the word of the Office for Budget Responsibility. Indeed, I urge the Minister to speak again to his party leader and say to him, “When we come to make manifesto commitments, let’s run them past the Office for Budget Responsibility,” so that the public know whom they can trust on money and particularly on the NHS.
	I remember serving on the Health and Social Care Bill Committee for many, many weeks—months, in fact; indeed, I believe it was almost a year of life. I remember my hon. Friend the Member for Leicester West (Liz Kendall) and I pleading with the Government not to go ahead—not to waste time and money on a top-down reorganisation; not to waste people’s heart and soul on a reorganisation of the national health service in a way that was unnecessary. We said, “All you’re doing is opening the door to privatisation. What you are doing is wrong for the national health service. You must stop. You must think again.” And there was indeed a pause—a pause for an awful lot of spinning—but the Government still forced through a profound reorganisation of the national health service that has allowed the market to come into the NHS and wasted £3 billion.
	We also said that if we needed to look again—and we did—at making our national health service appropriate for the 21st century, we should look at how to bring social care and health together. It is difficult, because social care is largely provided by local authorities. Very often it is means-tested and provided locally, with local accountability, whereas the national health service was much more nationally accountable, had much better funds and was not means-tested. However, without those two things moving and working together, we cannot have proper health care in our country, because—and we all know this—most people who use the national health service are elderly. They come to A and E in crisis, and once they are in they are unable to get out again. It is demeaning. It is humiliating. It is something that all of us in the Chamber will face unless something is done.
	People must be supported in the community so that they are able to live their lives as healthily as possible—yes, fighting off three or four long-term conditions, but still as healthily as possible. However, while this Government
	have been cutting the money to local authorities—it is being shovelled out the back door by Eric Pickles—the Health team have been saying, “Oh, it’s all right: we’re giving more money to social care.” But the Government know—and all of us who have friends, relatives or constituents who are using social care know—that there is not enough of it around. Old ladies are getting up and being taken out of bed and are sitting in their chair three hours later than they were before. They are getting visits of 15 minutes. They are not being looked after properly. They have the choice between having a bath and having a meal. In the 21st century, in one of the richest countries in the world, that is a disgrace. How can we really be looking properly at the future of the health service and allowing that to happen? Of course, if people are kept in bed until 11 o’clock in the morning and then being put back to bed at 5 o’clock in the evening, they will become unhealthy. They will end up in A and E in crisis and they will not be able to get out again.
	More and more local authorities are cutting back on social care and are giving social care only to those in the most acute need. In the time I have left—I do not have very long, so I am going to rattle through—I want to say what Islington does. Despite having the sixth-worst levels of child poverty in the entire country and one of the worst mental health records in the country, Islington provides social care on a level of which we should be proud. It provides social care at moderate levels. It is working with Whittington Health. The hospital in my constituency is working with the local authority, providing health in the community. The hospital sends people out; we have GPs working in the hospital. It is a model on which I hope the next Government’s—ours—model for proper health and social care will be based: the idea of people working together, looking at the whole person, giving the health service time to care and look after people properly, and giving people the right to die at home with dignity and support.
	I want to use the 30 seconds I have left to give due credit to Camden health services for allowing my father-in-law to die at home with true dignity and proper palliative care. It gave him the choice to die in his bed, next to his wife, for which I am profoundly grateful. I know that he was very privileged in being allowed to do that, because up and down the country that is not being allowed. It saved money, gave him what he wanted and gave him pride. Why are we not dealing with problems like that, instead of introducing the private market into our precious national health service?

Mark Spencer: It is a pleasure to follow the hon. Member for Islington South and Finsbury (Emily Thornberry).
	It is a little sad, to be honest, to be having this debate today, because we could approach this issue in a much more mature way as politicians. Clearly there are enormous challenges facing our health service and our adult social care services, not only for this Government or the next, but for the two Governments after them. As politicians, we owe it to our constituents to have a mature debate about how we are going to avert the demographic time bomb that is heading our way. Frankly, we all have an interest in that. Just like the hon. Member for Nottingham
	East (Chris Leslie), we are probably going to need those services at some point. I hope I will not find myself in a bed next to him, but we could end up on the same ward.
	It is worth saying that every Labour party election leaflet for the last 50 years has said, “You can’t trust the Tories with the NHS.” [Interruption.] Yet we have had countless Conservative Governments over that period, and the NHS continues to thrive, to look after people and to offer its services.

Grahame Morris: The hon. Gentleman is saying that the NHS is safe in Conservative hands, but let me remind him that in 1997, when Labour came to power, there had been 18 years—a considerable length of time—of under-investment. Expenditure on the NHS was increased 300% by the Labour Government: from £30 billion to over £100 billion. Every accident and emergency unit was rebuilt and many hospitals were rebuilt, too.

Mark Spencer: That is where the hon. Gentleman’s party falls down. Labour Members obsess about cash and forget about clinical operation. That is why we ended up with crises such as that at Mid Staffs hospital, with people dying in their beds because of bureaucracy, target setting and obsession with process rather than the care of patients.
	The Opposition also have an obsession with the private sector. My father had to have a new knee, unfortunately. He went to the local hospital, which happens to be the one that the constituents of the hon. Member for Nottingham East attend. Rather than being treated in the NHS Queen’s medical centre, he was sent to a hospital in Sherwood in his constituency, which looked after him very well. It was a private hospital and this was in 2008—under the previous Government. The NHS was making use of private services back then. It was very efficient and well delivered. I do not understand this obsession with the private sector. We need to remember that private companies make the drugs that the NHS uses; private companies make all the crutches and the ambulances; and GPs are, in effect, private companies. It works very well. As long as we can deliver a service that is free at the point of use and run in the most efficient way but with the highest levels of care and consideration, I think that is the right place to be.

Barbara Keeley: Let me return to my earlier point. Would the hon. Gentleman be comfortable if his constituents with cancer or those at the end of their lives had to contend with a totally privatised service? That is what we might have to contend with, because we might be faced with a 10-year contract to privatise all those services. It has never been done before, and it is highly risky—and the oncologists were not even consulted about it. We are not talking about supplementing; we are talking about private services replacing the NHS.

Mark Spencer: I thank the hon. Lady for that intervention. What my constituents who are in the unfortunate position of suffering from cancer care about is whether they are going to get better. Is the service going to deliver a service that makes them better and gets them over the disease? Frankly, if it does not cost constituents any money, and if the level of care and service is the highest, I think that is what really matters to them.
	It is easy to stand here and talk. Politicians talk—they will always talk—but we have to look at what politicians do. This Government, to their credit, have in this Parliament put in an extra £12.7 billion. Let us compare that with how politicians have operated in Wales, where the budget has been cut by 8%. I think it says a lot to our constituents about how the NHS is going to be managed in future and how much we genuinely care about and want to support the NHS system.

Helen Goodman: Is the hon. Gentleman not aware that central Government have cut the Welsh Government’s money by 10% and that health spending in Wales is now at an all-time high?

Mark Spencer: Of course, I am the first to admit that there is financial pressure within the system. The previous Government borrowed enormous amounts of money and ran up an enormous deficit. Any Government coming in at that time would have had to take difficult decisions, but the simple fact is that spending in England has gone up under this Government, while spending in Wales under the control of the hon. Lady’s party has gone down. There are some 850,000 extra operations a year taking place in our NHS by comparison with 2010.
	The issue that upsets me most and has brought me to attend this debate is the state of my own Sherwood Forest Hospitals NHS Foundation Trust. It “benefited” from a PFI deal signed under the previous Government, which now costs the trust £40 million a year out of its budget. That is where we went wrong under the previous Government. Let us spin that out: we were fortunate enough to invest £320 million in a new hospital, but it will cost £2 billion in repayments. I put it to Members that they would get a better interest rate from Wonga than they would out of that PFI deal. If we look at what happened nationally, we find that £11 billion-worth of investment through PFI matches up with £55 billion-worth of repayments. That means £44 billion being taken out of the NHS because of the shocking PFI deals signed by the previous Government.
	Labour Members talk about the cost of our reorganisation being £3 billion, but that is frankly nothing by comparison with £44 billion. It is an enormous amount of cash that could be spent on doctors, nurses, cancer patients and putting our NHS services in the right place.
	I am very fortunate that the Secretary of State has agreed to meet me and my hon. Friend the Member for Newark (Robert Jenrick) to try to help Sherwood Forest hospital trust out of the hole that the previous Government put it in. Hopefully, we can assist in dealing with the £40 million a year being sucked out of the trust.
	I am conscious that other Members want to speak, so I shall end there. I am grateful for having had the opportunity to speak.

Helen Goodman: I am pleased to follow the hon. Member for Sherwood (Mr Spencer). Last Saturday, I sat with my constituent Joanna Redfearn, who is a mother of four. Her 11-year-old daughter, Kelsie, has complex medical needs, including epilepsy. Joanna was telling me about the increasing difficulty she experiences in getting an ambulance to come when
	her child has a fit. She has been subject to waits of between an hour and two hours—clearly, that is totally unacceptable, because it is extremely dangerous for her child.
	A recent low point was when a paramedic turned up, who was told that a St John ambulance—not an NHS ambulance—was about to come. The paramedic rang the North East Ambulance Service to say, “Sorry, that will not do. They are not equipped to deal with this child’s needs. We need a proper ambulance.” My constituent is so desperate that she is considering moving house to be nearer to the hospital.
	This is part of a pattern in my constituency. When an elderly woman fell out of her wheelchair outdoors last summer, her husband, whose hearing is very bad, rang the ambulance service. The people on the other end of the phone began to challenge him and ask him a series of questions, but he could not answer them because he could not hear them. He could phone up and say, “I need an ambulance now”, but he could not hear well enough to engage in a long conversation with the ambulance service.
	After three phone calls a paramedic turned up, who then called a proper ambulance. The old man had to stand, propping his wife up for over an hour while the paramedics gave her the medical support she needed. It was fully two and a half hours before the proper ambulance came to collect her and take her to A and E. The worst case, however, is the one I raised with the Secretary of State a few days ago: that of Violet Alliston. Her partner rang 999 several times, but the ambulance arrived so late that she died.
	Everyone knows that the North East Ambulance Service is in crisis. The patients know, the GPs know and the paramedics know. The only people who do not seem to know are the Ministers. It is a shame that the doctor is no longer with us, because he made a number of comments, and it is unfortunate that he will not hear my response to them. He challenged what had been written by the independent Office for Budget Responsibility, which was set up by the Government to audit their public spending plans. It was the OBR that said that the Government’s plans would reduce spending to 1930s levels, and reduce by 1 million the number of public service jobs. It would be nice if the Minister responding to the debate told us which NHS staff will be included in that 1 million.
	Government Members seem to think that this is just a rhetorical device, and that none of us on the Opposition Benches have any such personal experience. That is not true. In the 1930s, my grandmother used to collect for an ambulance friendly society. What happened in the 1930s, under a 1930s system, was that if people did not pay, they did not get an ambulance. No one wants to return to that system.
	The problems I have described obviously have knock-on effects in hospital A and E departments. County Durham and Darlington NHS Foundation Trust met the four-hour waiting time standard on only 74% of occasions. Furthermore, services are constantly being removed from Bishop Auckland general hospital. The latest service the trust wants to remove is the maternity unit. Again, I am sorry that the doctor is not here to respond to my account of the problems we are experiencing. We have
	been told that maternity services are not safe because if something goes wrong during labour, the trust cannot guarantee that an ambulance will arrive to transfer the patient, even though the ambulance station is right next to the hospital. Of course the ambulance service is not working.
	I said to representatives of the hospital trust, “You are still dealing with home births. Surely the problems involved in collecting people from Bishop Auckland hospital by ambulance are exactly the same as those involved in collecting people if a home birth goes wrong.” They replied, “It is true that home births are risky, but people expect to be safer in a hospital.” In other words, what they are really bothered about is not health outcomes, but the risk of litigation. That is no way to run the health service.
	What the health service needs is a proper, well-funded plan, and that is what Labour’s motion sets out. We need to see changes in the culture, in the resources and in the management. Labour’s plan is honest, truthful, transparent and clear, and it is what the British people want.

Margot James: Let me begin by reminding the House of a few facts. This Government have presided over an additional £12.7 billion of public spending on the NHS, which amounts to a real-terms increase of 4%. That is a singular achievement, given that there have been cuts in every other area of public spending bar two—cuts forced on us by the Labour Government’s appalling management of the public finances.
	The public will judge as they find. Anyone who lives anywhere near the Welsh border will know that additional pressures on hospital services have arisen from the exodus of Welsh people in search of decent care. As Government Members have already pointed out, the Labour-run Welsh Assembly Government have cut the NHS in Wales by 8%. That contrasts very unfavourably with this Government’s 4% increase in spending on the English NHS. As I have said, the public will judge as they find.
	I want to say a little about our spending on health services in comparison with that of other countries. We are doing quite well at the moment. The European Union average is 8.7% of GDP; the United Kingdom figure is 9.2%, 0.5% higher, and is identical to the Australian figure. We also get a very efficient return on our spending. I applaud the NHS, certainly in my area, for all that it does with that money. Our system is considerably more efficient than the United States’, which is a privatised system based on private insurance. It costs a great deal more to run, and health outcomes are poorer because of the under-treatment of people who are underinsured, and the over-treatment of people who are insured properly. The administrative costs of the American system are also excessive compared with those of the publicly funded NHS.
	That is one of the reasons why I am so enraged by Labour’s lies and smears about our position on the NHS. We have no wish to privatise the NHS, even if we thought that was a good idea from an ideological point of view. I am an ex-business person, and if I took over the NHS, the last thing I would want to do is privatise it and create a system that would cost more to run and deliver worse outcomes.

Grahame Morris: I am sorry to interrupt the hon. Lady’s flow, but I want to defend the land of my fathers, Wales. I do not know whether the hon. Lady was present for the urgent question. We often measure the stress on the system according to the declaration of emergency and major incident plans. There have been 15 in England but, as far as I am aware, none in Wales.

Margot James: I do not want to cast aspersions relating to cover-ups and the like on some of the NHS management in Wales, but I think that some members of the hon. Gentleman’s own party have some salutary tales to tell on that front.
	However, as was pointed out by my hon. Friend the Member for Sherwood (Mr Spencer), this is not just about spending; it is about how we control the budget and what we get for the money that we spend. I appeal to those who rate the Labour party on the basis of its health policies to reflect on its record. They should remember how much Labour was borrowing when it was running the NHS, and that it was spending money as though it were going out of fashion.
	Under the last Government, the number of managers increased three times as fast as the number of nurses, and managers’ pay increased far faster than nurses’ pay. The management pay bill more than doubled under the last Government, but we have reduced it by nearly a fifth. There was absolutely no integration of health and social care under the last Government, although they had 13 years in which to put that right. Despite severe financial constraints, our record has been so much better than theirs, and that is the position I will put to my electorate when the time comes. We have produced 13,000 more doctors and nurses, and 21,000 fewer administrators and managers. That is what the public want to see. They know that this Government have the right priorities. In my area, that has translated to 353 more nurses and 84 more doctors in my hospital since this Government came to power. I congratulate our health ministerial team on not caving in all the time to producer interests—another facet of the last Government, with their command and control culture.
	I want to mention a few of the things I am proud this Government have achieved within severe spending constraints. We have ended the indignity of mixed sex-wards. We have reduced infection rates dramatically. C. difficile infection rates have come down by a staggering 63%. The last Government grappled with this issue for 13 years, leaving a disaster when they left office. They had an appalling record. Another great innovation—one of many; I have not got time to mention them all—is the Cancer Drugs Fund, which has helped many of my constituents to get the treatment they were denied under the last Government, with all their spending largesse. That has also flowed through to the hospital sector—imaging and radiodiagnostic tests have increased by 34%. All these benefits have been achieved with very small real-terms increases in spend. That is what this Government have been able to do: deliver more with less.

James Morris: Under the previous Government, all the in-patient wards in one of my local hospitals, Rowley Regis, were closed, but during the last four and a half years they have reopened, and there has been lots of innovation and new services coming into that hospital.

Margot James: That is a good example, and I know how hard my hon. Friend has worked in his constituency to assist in bringing about that improvement.
	The polls clearly show that the public have very little confidence in Labour’s proposals to manage the economy. However, I want to make sure I do everything I can to get the public to cast a weather-eye over the Opposition’s plans for the NHS, and to remember which party introduced privatisation into the NHS, and why. I remember calling on an elderly lady who had been waiting almost two years for a cataract operation on both eyes. That was what the previous Government presided over, and in desperation they called in the private sector to reduce those waiting times. They could not bring about change within the NHS because of their target-driven management culture and their command and control-driven philosophy, so they had to bring in the private sector.
	What we are seeing now is a tiny increase: the whole of the private sector accounts for less than 7% of total NHS activity, so we are talking about a small element that the Opposition are blowing up out of all proportion.

Barbara Keeley: Will the hon. Lady give way?

Margot James: I am sorry, but I am running out of time.
	Labour’s record in government, when the producer interest held sway, stands as a salutary lesson which I hope people will remember.
	No wonder there are serious divisions within the Opposition about their health policy, as was reported in the press only today. One Labour Front Bencher was anonymously quoted as saying that it would be a “fatal mistake” to increase the health budget without reforming it. I know there are some people with common sense on the Opposition Benches, but it is a shame they are not in control of health policy.

Several hon. Members: rose—

Lindsay Hoyle: Order. I must now introduce a six-minute time limit on speeches.

Liz McInnes: I have the real-life experience of having worked for the NHS for 33 years, and I am not a doctor.
	I have seen the NHS go through many changes, but I have never seen such industrial unrest and poor staff morale as has developed under this Government. This Government claim to have employed more doctors and more nurses, yet they are not talking about the cuts to other services and other staff, and the redundancies and the outsourcing of work to the private sector.
	This Government like to claim that all is wonderful in today’s NHS, but those of us who work, or have worked, within it know that that is not the case. The NHS still operates to a large extent on the good will of the staff. This Government have been withholding a pay review body-recommended rise of just 1% to all NHS staff. Only now that an election is looming has the Secretary of State finally agreed to meet the trade unions, and now that meaningful negotiation appears to have finally commenced and the strike that was planned for tomorrow has been suspended the Government are claiming that
	as some kind of victory. There is no victory, and this Government need to remember that they have presided over a series of strikes and industrial unrest on their watch and only now that there is an election on the horizon do they see fit to address these issues.
	I welcome this motion which proposes to invest £2.5 billion into our NHS. Staff have seen £3 billion being wasted on a costly reorganisation which nobody wanted, which was not necessary and which was in neither the Tory nor the Lib Dem manifestos. NHS departments such as the one I used to work in, pathology, have been making so-called efficiency savings for the last four and a half years, to the extent that if someone resigns from a post a business case has to be made for them to be replaced. In today’s NHS, decisions are being made not on clinical grounds, but on financial ones.
	It is an absolute disgrace that this Government’s spending plans will return our public spending as a share of national income to levels last seen in the 1930s, before we had an NHS. The Tories assert that they will protect the NHS yet propose to cut spending on services to levels seen in countries where almost half the health service is privately funded.
	The Government even deny that the NHS is being privatised on their watch, yet the evidence is of piecemeal privatisation of services. In my own area of the north-west, ambulance services have been privatised and are now run by Arriva transport, a bus company. This service is a source of constant complaints from my constituents, with patients being left to wait and being unable to get hospital for important medical tests. Medical staff tell me they struggle to get through Arriva’s complicated system of questions and answers—to which my hon. Friend the Member for Bishop Auckland (Helen Goodman), who is no longer present, has already referred—in order to secure patient transport.

Andrew Gwynne: My hon. Friend is making a great case and is absolutely right about Arriva and its patient transport service in Manchester. Is she aware that many of the hospital trusts in Greater Manchester are now having to put in their own arrangements, which is costing the public purse even more, because of Arriva’s failure?

Liz McInnes: I thank my hon. Friend for his intervention, and yes I am aware of that shocking fact. This contract needs to be looked at as a matter of urgency. The private sector is not providing the service that was commissioned.
	Medical staff have trouble getting the Arriva ambulance service to come out. If medical staff have difficulty getting through the question and answer system, imagine how patients must feel, and how they manage when they try to get patient transport from home to take them to hospital for urgent tests that need to be done in order to secure the treatment they need.
	My constituents also complain to me about GP appointments. A lot of them are unable to get GP appointments within a week, and this is supported by the results of the GP patient survey. If this Government are allowed to carry on as they have been, more and more people will end up waiting a week or more to see a
	GP or even be unable to get to see one at all. Labour will guarantee a GP appointment within 48 hours, and on the same day for those who need it, funded by our time to care fund, as opposed to suggestions made from the Opposition Benches such as “People with chronic illnesses like diabetes and thyroid disorders should be charged for their drugs”, or “Patients should be issued with receipts for the costs of GP and A and E appointments.”
	The NHS is not safe under this Government, and most NHS staff are aware of that. Only Labour can reverse the damage currently being done to our NHS.

Chris Heaton-Harris: It is a pleasure to follow the hon. Member for Heywood and Middleton (Liz McInnes). I know that she cares passionately about our national health service, as well as having considerable experience of it. I want to start by mentioning some massive positives and some points of agreement with the Opposition. Everyone in this place knows that the NHS at all levels gives their constituents incredible care. Yes, some people occasionally complain when things go slightly wrong, but they are relatively small in number compared with the quantum of folk who come through the NHS’s doors every day.
	Yes, I am going to make the points that every Conservative and coalition Member will make about the NHS budget going up by around £12.7 billion in cash terms over the course of this Parliament, about the fact that we have had 850,000 more operations being delivered each year compared with 2010 and about the fact that the number of MRSA bloodstream infections and incidences of clostridium difficile are at an all-time low. I am also going to make the point that more than 1.3 million more people have access to an NHS dentist. When we came into office, that was really difficult for people to do. We all remember the bad old days.
	Given our excellent track record, I am surprised that the Opposition want to talk about the NHS quite so much, especially when their plans include extra spending that they simply cannot account for or that they have already spent several times over. I should not be surprised, however, because although I am sure that every individual Labour MP truly does love the NHS, they are complicit in their leader’s bizarre plan to weaponise it. They want to forget about the NHS caring for people and instead use it for political advantage.
	Alas, I have seen such weaponisation locally in my county, where Labour has deliberately tried to scare vulnerable people by saying that hospitals or services are going to close. During the Corby by-election campaign—I informed the hon. Member for Corby (Andy Sawford) that I was going to mention him and his constituency—Labour ran a petition against the closure of Kettering general hospital. The hospital is not in the Corby constituency, and it was not going to close. During the campaign, I went to the Lakelands hospice in Corby, where I met a lovely elderly lady. She told me how afraid she was that the hospital that she was going to was closing. Just in case hon. Members think I am making this up, that exchange was witnessed by a local BBC television crew. I know that the hon. Member for Corby has learned from that experience and that he is now working with my hon. Friends the
	Members for Wellingborough (Mr Bone) and for Kettering (Mr Hollobone) to get better services from Kettering hospital.
	The Opposition have even tried to scare people by using that disgusting tactic in my own constituency. Last week, I received an e-mail from a local Labour activist who told me that Danetre hospital would close if my party won the next election. That is a common theme among Labour party members when they talk to the public in my constituency. Danetre hospital is a fantastic NHS resource in the town of Daventry, but it remains under-used by the hospital trust that controls it. However, the trust is looking into using it better, and I have met its chief executive, Dr Sonia Swart, to talk about the plans for the hospital. It has two operating theatres and 28 beds. It also has free parking—a phenomenal thing in our NHS. I have been assured by everyone that Danetre hospital is here to stay, but I knew that anyway. How did I know? Because it has 22 years remaining on an amazingly expensive private finance initiative deal that costs about £3 million a year to fund.
	Perhaps now is the time for those on the Opposition Front Bench to apologise for what they are allowing to happen in their name. But they will not, because they are weaponising the NHS, and they have a track record of doing that nationally. I seem to remember a national campaign in March 2012 about there being 24 hours to save the NHS. At 3 pm today, 25,047 hours will have passed since that campaign was launched, yet the NHS is still serving millions of people in our country.
	The Opposition criticise the private elements involved in the NHS but they will not tell us how much private sector involvement is acceptable to them. It was introduced on scale by the Labour Government and went up to 4.4% on their watch. It is now nearly 6%. What percentage is acceptable to those on the Opposition Front Bench? Perhaps they would limit the areas in which the private sector could operate. Maybe there would be no more private cancer care—we heard that mentioned earlier. It would be interesting to tell that to someone suffering from cancer who might be getting better treatment at the moment. Perhaps the Opposition would put an end to hip replacements and MRI scans being performed outside the NHS. Which private sector involvement do they think is bad?
	Yes, there are issues with NHS finances. Demand is massive; it is higher than ever before, and the NHS is treating more people than ever before. I sit on the Public Accounts Committee, and we have looked at many NHS projects and items. Perhaps an Opposition Member would like to stand up now and say how proud they are of the 2004 GP contracts, of the consultants’ contracts or of the NHS IT contract that cost the NHS and the country £10 billion in waste. Some salaries in the NHS seem very high. The chief clinical commissioning officer for the Vale of Glamorgan CCG is paid £185,000 a year, with pension and benefits, despite the fact that NHS England recommends a pay band of up to £100,000. NHS finances are safe only when our national economy is strong and growing. They are safe only under this party’s leadership.

John Woodcock: I have a great deal of affection for the hon. Member for Daventry (Chris Heaton-Harris), but I have to say to
	him that the only people who are using that word are those on the Government Benches, because they apparently have nothing to say about the future of the NHS under the stewardship of a Conservative Government—God forbid—or about the real crisis that our accident and emergency services are suffering across the country. I should like to hear a little more from them about what they actually plan to do, rather than hearing this ridiculous nonsense.
	We all know that the national health service faces major funding challenges in the years to come. NHS England has set that out clearly, and we have put forward concrete proposals to raise the extra money that our NHS needs. That will involve increased funding and, I have to say, radical reform. The merging of health and social care is a major undertaking that will unlock huge efficiencies and deal with one of the major pinch points of inefficiency that is wasting billions of pounds as well as creating great difficulties in people’s lives. Families simply do not know where to turn at the moment.
	That scale of ambition has not been matched by the Government. In fact, at the very moment that they should be encouraging front-line workers to innovate and work together from the bottom up to come up with the new ideas necessary to take the NHS to a new level, they are tying them up with the red tape of compulsory competitive tendering. That is the last thing those people need at a time when a radical new approach to delivering services is needed.
	I want to focus on the specific funding situation in the University Hospitals of Morecambe Bay NHS Foundation Trust. It is regrettable that the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who is a doctor, refused to take my intervention on the subject of maternity services. He must know, given that we have been talking about my maternity unit and maternity services across the Morecambe Bay area for some years now, that the situation is now critical. It will be the subject of a major report in the next couple of weeks, and there are real funding issues involved.
	I shall run briefly through the trust’s recent funding history. In 2011, the University Hospitals of Morecambe Bay NHS Foundation Trust announced that it was facing a cut of £15 million—around 4% of its annual budget—as a result of the efficiencies and cuts to hospital funding being required by the Government. At that stage, it managed to avoid reductions in front-line staffing and facilities. The required additional spending resulting from the clinical and staffing failures found by the serious Care Quality Commission reports led to the trust’s finances falling into deficit by about £25 million annually. Ministers are still insisting that that must be eliminated.
	The Better Care Together reconfiguration plan was submitted to NHS England and Monitor by the trust last July. It set out a scheme that would allow for up to £18 million of annual savings achieved over a five-year period. The trust, NHS England and the Department have been going backwards and forwards on the details of this plan, but it has boiled down to this basic point: innovative changes in approach and some difficult decisions mean that local health care experts are proposing to reduce the trust’s deficit by a full 70%, but—this is the key point—our whole area is clear that the unique
	combination of geographical isolation, poor transport links and severe health needs in pockets of some of the worst urban deprivation in the country in Barrow makes this a unique case, meaning we cannot go further than that 70% proposed reduction without cutting deeply into vital services across our hospitals.
	It is a shame that the hon. Members who represent the Royal Lancaster infirmary, which is part of Morecambe Bay’s trust, are again not here to make this case. However, I want to ask the Minister something, and she can rise now or deal with this in her summing up. Will she follow the lead of the shadow Secretary of State, recognise our unique case and pledge to bridge the gap? Until we get that promise I will keep working with anyone in our community across Morecambe Bay who will join us in demanding the funding deal our hospitals desperately need.
	The hon. Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Morecambe and Lunesdale (David Morris) are not here to stand up for their hospital today, so I will be out at the weekend with the people who will replace them as MPs: our brilliant candidates Amina Lone and Cat Smith. We will not stop until our hospitals are secure. The Government are proving themselves to be not up to this job, so they should get out of the way.

Charlie Elphicke: When I was first campaigning in Dover and Deal, I found that the previous Government’s legacy was that they had run down the much-loved Buckland hospital in Dover. Wards had been axed one by one; services had been withdrawn one by one; and the hospital had been decimated for more than a decade. There had been talk of plans to build a new hospital, but they had gone nowhere for the better part of a decade. It was a total disgrace; we did not get a fair share of health care in Dover and Deal.
	In addition, an agreement appeared to have been made by the hospital trust in 2006 to take away the out-patient services at Deal’s hospital. There were claims of a consultation with the then MP and the then elected representatives to withdraw those out-patient services. So when I was elected I faced a situation where the hospital trust wanted to axe out-patient services and people were very concerned that Deal’s hospital was so undermined that it would be lost altogether. That was unacceptable.
	What did the Conservatives do about it? Thanks to our funding of the NHS—the amount of money we have put in and the increase in spending in real terms—we managed to get a new hospital being built and it opens in March. That is a real achievement, ensuring that we will have a fairer share of health care back in Dover. After the years of going backwards, we will go forwards, and people in our community will be able to be seen and cared for in our community. Rather than have Deal’s hospital being run down and closed, as people feared, because Labour left it teetering on the edge, we campaigned hard. I undertook a large survey across the whole of Deal and I listened to people’s views. Thousands responded and we had hundreds in a meeting in a church to listen to the doctors and put the case for keeping the hospital, and now the clinical commissioning group, using its
	new funding powers, is ensuring that that hospital is safeguarded for the future. In that way, under the Conservatives, we have safeguarded Deal’s hospital and we are getting a new Dover hospital.
	We also had difficult times in our local hospital trust—the East Kent Hospitals University NHS Foundation Trust had the CQC come in and investigate. In the past there would have been a cover-up and things would all have been swept under the carpet, just as they were in Staffordshire. That was the disgrace under the previous Government; the shadow Health Secretary oversaw that shameful episode. This Government have been open, honest and frank about the situation, and have ensured that special measures are taken and that we will have more nurses, more investment and better health care as a result. That is an important milestone. It shows not only that we have a new Dover hospital and that we have safeguarded Deal’s hospital, but that we have a better trust thanks to the reforms the Government have put in place.
	But I think we should go further. I want to see five-star health care in Dover and Deal, so that rather than the cold wards of old, we should have new individual care and recovery suites, which can enable flexibility. People could be there for short-time observation; for step-down care for a week or two, rather than blocking up the acute hospital; for re-ambulation over a two to three-month period; or for much longer-term palliative care or perhaps end-of-life care. I am working with Kent county council, the local CCG and other health stakeholders to examine how we can bring forward that sort of innovative proposal. It will help with NHS funding because it will save money lost through bed-blocking; it will save money because its beds will be less expensive than elsewhere in the NHS; and it will provide a better experience for patients because they will be able to get better and recover within the community.
	We need to rethink A and E more generally, by having more local emergency centres. My plan is that at the new Dover Buckland hospital, which opens in March, we should see a local emergency centre being used as an out-of-hours base for the doctors and CCG. It should be beefed up so that it has a much more emergency flavour to it, rather than a minor injuries one, so that more people use it, more people have trust and confidence in it and fewer people will inappropriately admit themselves to A and E down the road in Ashford. In that way, we will be able to get the right kind of cascading, the right level of treatment and the right places, given how our health system works. Such an approach would allow simpler stuff to be carried out more locally in our communities, whereas the more complicated accident and emergency problems would be dealt with in a more centralised A and E unit. That kind of modernisation in how we deal with out-of-hours care and A and E-type care is something I hope we will think about and see more of in future. I do not see this as a left/right issue, just as I do not see community hospitals, which I believe in, as a left/right issue. I see it as being about people who are concerned about localism, and the localisation of health care and bringing it closer to the patient and to the community. That is the way we should be building the future of our NHS. It is a great shame we have seen so much politicisation and weaponisation of this—

Lindsay Hoyle: Order. I call Grahame M. Morris. You have five minutes.

Grahame Morris: I am pleased to follow the hon. Member for Dover (Charlie Elphicke). I wish to make it clear that I have chosen to be here in the Chamber today to participate in this important debate rather than attend the Health Committee, which is also considering important matters, because I feel that we need to set out our view of the direction of the health service.
	I was very interested in some of the hon. Gentleman’s views about fair funding. Having experienced NHS funding under the Conservatives and Liberal Democrats, I must say that my view is rather different. After the general election in 2010, the funding for a brand new hospital that would have served my constituency—it was to be funded not through the private finance initiative scheme but by NHS capital—was cancelled by the present Government. It is an absolute disgrace that we still do not have modern facilities to serve my constituents and those of neighbouring constituencies. It prompts us to ask whether fair funding or some kind of gerrymandering is being applied.
	The hon. Gentleman was talking about opening urgent treatment centres. That is a revelation to me because the two centres that opened in my constituency under the previous Labour Government are now threatened with closure. We have neither a modern hospital nor modern facilities.
	I am proud to say that, although I am not a doctor, I did work in the health service. Like my hon. Friend the Member for Heywood and Middleton (Liz McInnes), I worked in a pathology laboratory, doing some important diagnostic work. I am proud of the people who deliver that service; I think they deserve enormous credit.
	The creation of the NHS is Labour’s proudest achievement. More than anything else—more than football or cricket—it is what binds us together as a nation. The principle of a free national health service, which is free at the point of use, has huge popular support among the general public.
	When the Prime Minister said that his priorities could be summarised in three letters—NHS—we might have been forgiven for thinking that the Conservatives had been transformed and had come to cherish the NHS as much as the British people do. But, with fewer than 100 days to the general election, it is apparent that his words were nothing more than a smokescreen. It is clear that the Government knew that they could never go into a general election stating their true intentions. Now, we have been accused of weaponising the NHS.

Charlie Elphicke: Yes, you have.

Grahame Morris: I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, the hon. Member for Redcar (Ian Swales) has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our
	national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.
	I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—

Lindsay Hoyle: Order.

Diana Johnson: I have been a Member of Parliament for nearly 10 years and I have never had so many complaints about the NHS as I have received in recent months. In a recent survey that I carried out, more than 35% of people who responded had had to wait more than a week to see a GP. I have seen many parents who are concerned about the length of time they have waited for their children to receive a diagnosis of autism, or to get an appointment with child and adolescent mental health services. Our four hour-target rate at A and E in Hull stands at about 74.9%, which is one of the lowest in the country. We also have very high levels of cancelled operations.
	We now have a new chief executive, who is doing his very best, with a dedicated team of front-line staff, to deal with the pressures on A and E, and I want to pay tribute to them for their work. However, what I really wish to focus on in this short contribution is a report on financial irregularities, which has been published on the front page of my local newspaper today. It concerns the regime that existed under the former chief executive of Hull Royal Infirmary, Phil Morley, who left the hospital very suddenly last April, just before the publication of a very damning report by the Care Quality Commission, which outlined concerns about bullying, staff shortages and the care that was being provided at the hospital. Within a few months of his leaving and the damning report, he turned up as a chief executive at the Princess Alexandra hospital in Harlow, earning—I found out from a freedom of information request—£170,000. The report published this morning is a leaked report, but I want to read this out, because I am sure that all hon. Members will be concerned to learn what has happened to NHS money:
	“In a draft report leaked”
	to the Hull Daily Mail
	“external auditors KPMG, called in to investigate financial concerns, said there was ‘an undeclared conflict of interest’ between Mr Morley and chief operating officer Amanda Pye. The NHS watchdog for hospital trusts was asked to consider calling in a team involved in examining financial irregularities and suspicions of fraud ‘due to the seniority of staff involved and potential conflicts of interest’.”
	That included—I am sure that hon. Members will be concerned about this—payment for a sunset cruise on a luxury yacht in 2012 for Mr Morley and senior members of his management team in Florida. It also says:
	“Mr Morley amended draft minutes from a committee set up to approve salaries and additional payments to staff”.
	This includes a payment made for a relocation allowance, when there was no relocation, and the person ended up
	having to pay £8,000 back to the trust. As I have said, there was a conflict of interest between Mr Morley and a senior member of his team.
	This has all come to light as a result of the investigative journalism by Allison Coggan at the Hull Daily Mail and by Vicky Johnson at the local BBC. I think it is shocking that the chair of the audit committee, when asked on television by Vicky Johnson why she had not challenged what the chief executive was doing, said that she was scared to challenge him. This is NHS money, and we know that every penny counts. I have raised this on the Floor of the House with the Secretary of State. Initially, he said that there was nothing he could do about it, so I wrote to him and received a letter from the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), saying that there was nothing that could be done. Finally, we had a meeting with the Secretary of State, who has arranged for the Trust Development Authority to investigate what was going on in that trust.
	It is of concern to many hon. Members and to me that where there are financial irregularities in the NHS, it seems that chief executives can move from one trust, having made a mess of things, straight into another job. It seems as if they are protected, which it is fundamentally wrong when it is NHS money—public money. My constituents will certainly be worried about the story on the front page of today’s Hull Daily Mail, and the fact that this individual is still in a post paid for by the NHS in another part of the country earning a lot of money. I hope that the Minister can reassure me that the TDA will do a thorough and proper investigation into what went on in that trust, because it is not acceptable that this man still holds a chief executive position.

Eilidh Whiteford: I apologise for not being in the Chamber for the beginning of the debate.
	The issues raised in today’s debate about the challenges of providing health care for a population that is ageing and living longer with complex health conditions in a context of fiscal austerity and rising costs are some of the most pressing ones facing us as policy makers. We all acknowledge that it is difficult and there is no easy sound-bite solution to the long-term challenges, but I do not believe that those challenges are insurmountable if we are prepared to prioritise health spending and address pressure points in the system.

Lilian Greenwood: It is interesting that the hon. Lady was talking about the costs of an ageing population. Is she aware of Monday’s report by Action on Hearing Loss, which showed that as a result of budget cuts and rising demand two out of five audiology departments offer patients a reduced service? The chief executive of Action on Hearing Loss described that as having a cruel and senseless impact on people with hearing loss. Should the Government not respond to that?

Eilidh Whiteford: I was not aware of that report, so I am grateful to the hon. Lady for pointing it out.
	We all know that we do not have one NHS in the UK—we have national health services in each of the home nations that operate independently of one another
	and are accountable to the devolved institutions—but it is worth noting that in recent years our distinct national health services have gone down divergent policy paths. Those of us who remain committed to comprehensive health care, available free at the point of need, understand that the model is under ideological threat. I have been horrified by the NHS reforms in England that have removed the statutory duty of care, and that, as we speak, are enabling the creeping privatisation of services. For the sake of the peoples of these islands, those reforms need to be reversed, because the reality of devolution is that Westminster still holds the purse strings. The funding formula by which the devolved Governments receive their block grants is directly related to budget decisions made for England in devolved policy areas, so decisions to cut spending in NHS England, or to privatise services, have a direct knock-on effect on the money made available to the Scottish Government.
	There has been a 10% cut in Scotland’s fiscal resource budget since 2010, and a 26% real-terms cut in Scotland’s capital budget. Nevertheless, the Scottish Government have increased the health resource budget by 4.6% in real terms, and every penny of additional budget consequentials accruing from health spending has been spent on health. This coming year, health spending in Scotland will break the £12 billion barrier for the first time.
	The practical consequences of increased health spending in Scotland can be seen in record staffing levels—up 6.5% overall, with record numbers of consultants, over 1,700 more nurses and a 7% increase in GPs. We have cleaner hospitals—cases of MRSA are down 88%, and C. diff is down 81% in elderly patients since 2007. Our waiting times for in-patients and out-patients have improved dramatically. More than 97% of in-patients were treated within the 12-week target in the last quarter, and 90% of patients are now being seen and treated within 18 weeks of initial referral. Perhaps most telling of all, there has been a drop in the hospital standardised mortality ratios of almost 16% since 2008 and a sizeable reduction in premature deaths in the most deprived areas. And we have honoured our pay commitments to our NHS staff.
	The Minister and other Members have today made many comparisons between the NHS in England and the NHS in Wales, but there have been no comparisons with the NHS in Scotland. That is because across a range of indicators the Scottish NHS is outperforming the NHS elsewhere, precisely because we have not gone down the privatisation route.
	Just yesterday the brand-new Southern general was handed over to the NHS—an NHS hospital, paid for without the use of discredited private finance initiative or public-private partnership schemes that have been an atrocious waste of public money and are still costing NHS Scotland over £225 million a year. In the north-east, anyone visiting Foresterhill can see all the building work that is going on to improve facilities. Under previous Governments, NHS Grampian was severely short-changed by the funding formula, but the SNP Government have been closing that gap and next year will put in an additional £49 million, a 6% funding increase to bring it into line with other health boards.
	We cannot be complacent about the pressures on our NHS. Despite the best efforts and commitment of staff, our NHS is under strain and it does not always get it right. As MPs we often see when things go wrong, but
	we need to see that against a background of increasing patient satisfaction overall and continuing improvement in patient care, despite enormous pressures. We heard earlier today that some of the pressure on A and E emergency care is a consequence of people having problems accessing primary care. Another area where pressure in one part of the NHS has extensive knock-on impacts is in relation to delayed discharge, which puts tremendous strain on patients, whether they are stuck in hospital desperate to get home, or stuck at home desperate to get into hospital for treatment, because no beds are available.
	The Scottish Health Secretary announced an additional £100 million earlier this month to address delayed discharges, but the underlying issues are not just for the NHS. Back in 2010 the report of the Christie commission highlighted, among other things, the need for joined-up services between health boards, local authorities and others, and preventive early interventions to meet the challenges of rising costs and changing demographics in the context of tight public finances. In Scotland, much progress has been made since then, but nobody would pretend that there is not a lot still left to do, or that the process is straightforward. However, we just need to look at how the non-means-tested free personal care has enabled thousands of people to live at home to see the human benefits of what is increasingly being recognised as a cost effective-policy.
	It is precisely those efforts to join up health and social care that are threatened by the austerity agenda and the promises of further cuts that both Front-Bench teams seem to have shackled themselves to. Local authority budgets are already under pressure, and further cuts to the public services that they provide, including social care and preventive early intervention work, risk driving up still further the acute pressures on our NHS. Our NHS is precious. Most of us depend upon it. We need to prioritise it and provide the resources that it needs to meet changing demands on it.

Liz Kendall: It is a pleasure to close the debate. There have been some passionate speeches from Members on both sides of the House who are really standing up for care for their constituents. My hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) talked about the excellent joined-up care provided by the Whittington hospital, which I was privileged to visit, and the excellent work of Islington council, which is still funding social care for people with moderate needs and ensuring that all its home care staff are paid the London living wage, including for travel time.
	My hon. Friend the Member for Bishop Auckland (Helen Goodman) talked about the terrible problems with long ambulance service waits, and my hon. Friend the Member for Heywood and Middleton (Liz McInnes) talked about the difficulties with the Arriva patient transport service, a problem I have in my constituency, where there have been some appalling lapses in the quality of care.
	My hon. Friend the Member for Barrow and Furness (John Woodcock) talked about the huge financial problems facing his trust, and made a powerful case for its uniqueness in terms of its geographical position and transport links, such that it needs to be looked at
	seriously in future. My hon. Friend the Member for Kingston upon Hull North (Diana Johnson) expressed concern about financial irregularities in her trust, which I hope we can get to the bottom of. My hon. Friend the Member for Easington (Grahame M. Morris) did not get much time to speak, but I agree with him that the NHS, perhaps more than football or cricket, is what makes us proud to be British.
	Our NHS faces huge challenges: our ageing population; the increase in people living with long-term conditions; drugs and medical technologies advancing at incredible speed; and public expectations changing rapidly too. Meeting these demands, when the NHS faces the tightest financial settlement of its life, requires a Government who are laser focused on ensuring that all our services get the best results for patients and offer the best value for taxpayers’ money.
	In practice, we know that this means that some services must be provided in specialist centres, so that patients get expert treatment 24/7. Others must be shifted out of hospital into the community and towards prevention, to help people stay living at home. All services—physical, mental and social, across hospitals and in the community—must be properly joined up and personalised, so that people have the right care, at the right time, in the right place. We also need bold action on public health to prevent long-term illnesses such as diabetes, obesity and heart disease from developing in the first place and to ensure that the NHS is sustainable in future.
	In the light of those huge challenges, what did the Government do when they took office in 2010? They focused not on reforming front-line care, but on forcing through the biggest backroom reorganisation in the history of the NHS, wasting three years and £3 billion of taxpayers’ money. Ministers promised that they would cut bureaucracy, but instead they created 440 new organisations—not just NHS England, 221 clinical commissioning groups and 152 health and wellbeing boards, but four regional NHS England teams, 27 local area teams, 19 specialist commissioning units, Public Health England and Health Education England, and that is obviously alongside Monitor and the Care Quality Commission. It is a system so confusing that no one knows who is responsible or accountable for leading the changes that patients want and taxpayers need to ensure that the NHS is fit for the future.
	Ministers promised that their reorganisation would save money, but £1.4 billion has been spent on redundancy payments alone, and more than 4,000 people who were made redundant have since been re-hired elsewhere in the system. They promised to cut the costs of management consultancy—indeed, the right hon. Member for South Cambridgeshire (Mr Lansley) specifically promised that those costs would be reduced by 46% by 2014. Instead, these costs have soared as hospitals and CCGs spend good money after bad to try to make sense of the new system. Last month, the British Medical Journal revealed that NHS spending on management consultancy has not been cut by 46%; it has increased by 100% to £640 million. That is enough to run three medium-sized hospitals or employ 20,000 extra nurses.
	But the Government’s disastrous reorganisation does not even stop there. It is still going on. Primary care is being reorganised again because NHS England has finally realised that it cannot commission effective local GP services at a national level—just as Labour warned.
	Specialist commissioning is under review because NHS England has lost grip of the budget and realised that patients need specialist services that are joined up with local care—just as Labour warned. Support for GPs in their commissioning role is being reorganised too, with commissioning support units forced to merge and then—get this!—bid to be on a list of approved organisations, including private companies, that are allowed to sell their services back to the NHS. It is a Kafkaesque nightmare of incompetence and chaos written by the Conservatives and signed by the Liberal Democrats.
	As if all this was not bad enough, Ministers have made the pressures on the NHS even worse by cutting the services that help to keep people out of hospital and living at home. They shut one in four walk-in centres, scrapped the 48-hour GP waiting target, and removed Labour’s incentives for evening and weekend surgery appointments, so more people are forced to turn to A and E. They slashed social care budgets by £3.5 billion, so fewer older and disabled people get vital help to stay living at home. They cut over 2,000 district and community nurses, who help elderly people get back home from hospital and prevent people with long-term illnesses from ending up there in the first place.
	What is the result? More sick, elderly people in A and E, and more patients stuck in hospital, often for weeks or months at a time, when they could be cared for back at home. Over the past 12 months, delayed discharges from hospitals have cost the NHS £280 million. This could have paid for 6,500 nurses or a year of decent home care for 40,000 people. Where on earth is the sense in that? More patients are stuck in hospital, more people are forced to wait longer for treatment, and more planned operations are being cancelled. Patients are in distress, families are struggling, and staff are under intolerable pressure.
	Patients, staff and taxpayers cannot afford another 99 days of this Government, let alone another five years. They need Labour’s long-term plan for investment and reform, with an extra £2.5 billion a year, on top of this Government’s plans, to get the doctors, nurses, midwives and home care workers we need. We will join up physical, mental and social care services from home to hospital, with one team and one point of contact, to get families the support they need. We will introduce a year of care budget to create a powerful incentive for better home and community services, to keep people out of hospital, and to tackle the scandal of 15-minute home care visits. We will give more power and control to patients, with new rights to swifter cancer tests, better GP access, talking therapies and care at home. We will end the zero-hours contracts that exploit social care workers, so that elderly people finally know who is coming through their front door every morning and staff can properly plan their lives.
	At the next election there will be a real choice on the NHS. It will be a choice between care going backwards, services fragmented and money wasted under the Conservatives, or Labour’s plans to fully integrate services to get the best results for patients and the best value for taxpayers’ money. It will be a choice between the Conservatives, whose Prime Minister has broken his promise to protect the NHS and thrown the system into chaos, or Labour, who will make the real investment
	and reforms the NHS needs to meet the challenges of the future. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest and make even deeper cuts to social care, or Labour’s fully funded proposals and 10-year plan to ensure that the NHS is sustainable for the future. I commend the motion to the House.

Jane Ellison: It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall). In truth, I think we have heard a great deal more consensus about the future of our health services than the Opposition sometimes like to pretend. It has been obvious that Members in all parts of the House care passionately about their local services. They have spoken up clearly on behalf of local staff who are working so hard through this winter. I thank all hon. Members for their contributions.
	All Members speaking up for their constituencies are doing so because they care about their local health services. They also accept the challenge that the NHS and the whole health service in England is facing but is collectively rising to meet. Hard-working NHS staff do not need to hear the endless politically driven scaremongering that we hear all too often from Opposition Members. That was highlighted by my hon. Friend the Member for Daventry (Chris Heaton-Harris) and by many colleagues who have come here with scaremongering leaflets from their constituencies saying the very opposite of what is true. Far too much of that is going on. It must be absolutely demoralising for staff who are working hard in the face of winter pressures.
	Despite the huge financial pressures we were faced with when we came to office, such as the need to reduce the deficit we inherited, which was, as Members have said, the worst peacetime—

Grahame Morris: Will the Minister give way?

Jane Ellison: I will make some progress; the hon. Gentleman has made a contribution.
	Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.
	Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend the Member for Stourbridge (Margot James) set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding.
	That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.

Helen Goodman: The OBR says that the Government’s plans involve cutting 1 million public service workers. Will the Minister say from the Dispatch Box which 1 million public service jobs are going to be cut?

Jane Ellison: I remind all Opposition Members of their predictions about employment at the beginning of this Parliament. If any of them wants to remind us of those, they can be my guest.
	We recognise the significant and continuing pressure on services in the short term and the need to invest in new ways of providing care for the future.
	This Government have put more performance data in the public domain and have put an unprecedented emphasis on transparency. Indeed, some of the statistics Members quote in these debates are in the public domain only because the Government have put such an emphasis on transparency. Transparency is one of the key drivers of safety in our system.
	As public health Minister, I welcome the focus on prevention in the “Five Year Forward View”. I think this is common ground across the parties. Prevention has to be a key part of the NHS’s plans. When we keep people healthy and out of hospital, it is a win for them and a win for the NHS. Mention has been made of the national diabetes prevention programme. We will be the first country in the world to implement such a programme at scale to help prevent the onset of the disease and reduce demand on the NHS. Investing in the NHS with a focus on prevention is one of the keys to a sustainable footing for the NHS in the long term.
	Thanks to the work of NHS staff and the funding protection provided by the Government, the NHS is treating more patients than ever. Again, that flies in the face of all the dire threats about its peril. There are 9,000 more doctors and 3,300 more nurses. The additional funding announced by the Chancellor in the autumn statement will enable the NHS to continue to meet the rapidly rising demand in the short term, while making investments in new services and facilities to transform care for patients and ensure that the NHS is sustainable in the long term.

Barbara Keeley: The Minister mentioned an increase in the number of nurses, but there is no increase in the number of district nurses, of whom we have lost thousands. Week in, week out, the Health Committee keeps being told how serious that is for all aspects of care in the community.

Jane Ellison: I am sure that, like me, the hon. Lady will welcome the 589 new nurses in her trust.
	The more sensible Opposition Front Benchers have made it clear in interviews that the link between reform and investment is important. I want to pay tribute to the NHS, which is well on track to make up to £20 billion of efficiency savings to be reinvested in front-line care. For example, the NHS is securing savings of £2 billion a year as a result of the drive to tackle waste and improve procurement. Tough decisions were taken at the beginning of this Parliament to protect the NHS budget—against the advice of the Labour party—that have allowed us to
	strengthen family doctoring and reform out-of-hospital care. We all agree that integrating health and social care is important, and that is exactly why the Government have the £5 billion better care fund. It is an area on which—despite what Opposition Members say—there is significant consensus. They should support that fund instead of, as I recall, inviting us to put it on pause.
	We have heard about how Labour plans to raise more money for the NHS, but in 2015-16 it would raise nothing. The Government are already consulting on a tobacco levy. The tax on family homes, by the Opposition’s own admission, would not start until 2016-17 and has already been spent three times—paying down the deficit, funding the NHS, getting rid of the 10p rate. As a London MP, I have to say that the chance of the homes tax surviving Labour’s London mayoral candidate race is minimal, given the raining down of ire on it from Labour MPs in London. On top of that, Labour plans to spend an extra £5 billion, including more than £2 billion on committing equal resource to physical and mental health and more than £1 billion on GP access—it just does not stack up.
	We came into government with a long-term economic plan to reduce the deficit and build a stronger economy, with a commitment to protect and safeguard the NHS. We have kept that important promise on the NHS and we kept our promise on the success of our economic plan. We recognise that the NHS still faces significant challenges, both short and long term, as the hon. Member for Leicester West (Liz Kendall) laid out—rising demand, an ageing population and growing expectations—but it is only through sticking to our long-term economic plan that we are able to put the investment in. We are making a down-payment of £2 billion on the NHS’s five-year forward view and we fully support the long-term vision for the NHS, by the NHS—by the most senior and experienced clinicians in our country. The Government have committed to put more resources in now and in the future to give all our constituents a better service, free at the point of use and fit for the future.

Question put.
	The House divided:
	Ayes 228, Noes 298.

Question accordingly negatived.

Sustainable Development Goals

[Relevant documents: Seventh Report from the Environmental Audit Committee, on Connected world: Agreeing ambitious Sustainable Development Goals in 2015, HC 452.]

Mary Creagh: I beg to move,
	That this House recognises that 2015 is an historic year for development as the countries of the world come together to negotiate the binding climate change agreement at the 2015 United Nations Framework Convention on Climate Change and the Sustainable Development Goals; believes it is unacceptable that more than one billion people still live in extreme poverty on less than $1.25 a day; notes that the effects of climate change will be most severe in some of the world’s poorest countries; further recognises that the UK has a leading role to play in these negotiations; regrets that the Government failed to bring forward legislation to enshrine in law the commitment to spend 0.7 per cent of Gross National Income on international aid as set out in the Coalition Agreement; further regrets that this Government has failed to support standalone Sustainable Development Goals on health and climate change; and calls on the Government to show global leadership on tackling the causes of poverty inequality and climate change.
	This year, 2015, is an historic year for development. The countries of the world will come together at the United Nations in September to agree the sustainable development goals, and in Paris in December we will agree a framework to tackle climate change. These agreements would be priorities for a Labour Government. We have called today’s debate—the first since the debate on Burma in 2008—to set out the differences that we see between this coalition Government and Labour on these vital issues.
	Fifteen years ago, a Labour Government led global efforts to tackle extreme poverty, which led to the millennium development goals. These goals have produced fantastic results. Every day, 17,000 fewer children die. Nine out of 10 children in developing regions now attend primary school and we have halved the number of children who die before their fifth birthday. In 2002, just 700,000 people received treatment for HIV. The last Labour Government helped to found the global fund to fight AIDS, TB and malaria. Today, 13 million people access life-saving HIV treatment. We cancelled debt, increased aid and outlawed cluster bombs, and when my right hon. Friend the leader of the Labour party was Secretary of State for Energy and Climate Change, the UK became the first country in the world to put into a law a target to reduce carbon emissions. Other countries, such as Finland, Denmark and Brazil, have followed that lead.
	But, today, more than 1 billion people still live on less than $1.25 a day, so the new sustainable development goals must go faster to eliminate extreme poverty and, vitally, tackle growing economic inequality.

Caroline Lucas: I appreciate the call that the hon. Lady is making for UK leadership on climate and poverty issues. Does she recognise that her party’s support for things such as maximising oil and gas extraction in the Infrastructure Bill, agreed just a few days ago, is undermining the pledges she is now making to tackle climate change?

Mary Creagh: Not in the slightest. I will set out in detail tomorrow, on a visit to the Institute of Development Studies in Brighton, our plans to expand what we want to do, particularly in the area of universal health coverage. Perhaps I will bump into the hon. Lady on the pier down there.
	There are three vital areas that Labour would prioritise to tackle inequality: universal health coverage, human rights and climate change. I will say more on those issues in a moment, but first I would like to look at this Government’s approach. We regret that the Government failed to bring forward legislation to enshrine in law both parties’ manifesto commitment to spend 0.7% of gross national income on international aid. It fell to Labour MPs and the good offices of my right hon. Friend the Member for Tynemouth (Mr Campbell) to ensure that the landmark Bill that would do so was passed in this House.

Caroline Spelman: I am grateful to the hon. Lady for giving way, but does she accept that trying to set out the dividing lines between the parties on the subject of international development breaks a consensus that has existed for a long time? I think the outside world looking in would fail to understand that it is this Government, whom she seeks to criticise, who have met the 0.7% target.

Mary Creagh: I have the greatest respect for the right hon. Lady, but she too led an Opposition day debate on trade justice in 2002—I read the report of it in Hansard only last night—so I shall take no lessons on having Opposition day debates on this matter from her.

Stephen O'Brien: rose—

Mary Creagh: I am going to make some progress.
	There is nothing wrong with supporting the private sector and infrastructure investment in poor countries, but we Opposition Members have grave concerns about the lack of transparency over where this funding for private sector development is going. That area will account for £1.8 billion—nearly one fifth of the Secretary of State’s budget next year.

Malcolm Bruce: Just before this debate, the Select Committee was taking evidence from the Secretary of State on precisely the issue of private sector investment, but not a single Labour member of the Committee attended the session.

Mary Creagh: Perhaps my hon. Friends were writing their speeches. I know that my hon. Friend the Member for East Lothian (Fiona O'Donnell) is planning to speak in this debate. I pay tribute to the work of the Select Committee, which the right hon. Gentleman chairs, and I shall quote extensively from some of his reports, if he will give me the chance.

Andrew Mitchell: rose—

Mary Creagh: I am going to make my point, and this will interest the right hon. Gentleman because it is a body that he set up. The Independent Commission for Aid Impact has been highly critical of the Secretary of State’s TradeMark Southern Africa programme. It found
	that an £80,000 illegal payment was made to the Government of Zimbabwe in breach of the Government’s own rules.

Justine Greening: Let me point out that that programme was set up by the hon. Lady’s Government.

Mary Creagh: Shock, horror! The right hon. Lady’s multi-annual review in 2011 talked about that programme and found that it was working well. The payments I refer to were made between July 2011 and May 2013—on her watch. The commission said:
	“We are…deeply concerned that…a private company is managing a £30 million DFID programme without any formal contract with…DFID.”
	That is a direct quotation from ICAI. It details serious weaknesses in financial management, with 90% of all expenditure undertaken in cash, without securement or contract—for example, a $20,000 cash payment with a hand-written receipt from an off-the-shelf receipt book; a request for a $100,000 petty cash fund; and a request by newly recruited staff to be paid tax free, which is against South African law. As I say, the review of the capital budget that the Department carried out in October 2011 found that most outputs had been achieved, but after three years of the current Secretary of State being in charge, the third annual review found that DFID was not on track to meet its financial forecast—on her watch.
	To her credit, the Secretary of State has shut down that programme, but similar problems persist elsewhere. ICAI’s report into DFID private sector spending published eight months ago found that it was
	“impossible to identify how much DFID actually spends on private sector development…because it is not captured as a discrete category of expenditure in DFID’s financial system.”
	That leads to the question: “If you don’t know where it’s going, how can you measure if it is working?”
	The National Audit Office has criticised another private sector project—the Private Infrastructure Development Group. The NAO criticises the right hon. Lady’s Department’s decision to scale up PIDG funding from a total of £49 million in 2010-11 to £258 million in 2012-13. Her Department will allocate £700 million-worth of taxpayers’ money to that fund between 2012 and 2015. The UK now accounts for 88% of all contributions. The NAO criticises the fact that there was no change to PIDG’s governance and that the business cases for projects were not assessed by DFID’s quality assurance unit—despite the risks involved. The NAO concluded that DFID has inadequate financial control and oversight, lacks robust information and was unable to prove value for taxpayers’ money.
	I share the NAO’s and ICAI’s concerns about where and how this £1.8 billion is being spent. I have put a series of parliamentary questions to the Secretary of State about where the funding for her strategic framework for economic development is going. I asked the right hon. Lady how the money would be ”targeted on economic development”, and how it would be
	“allocated to different activities and countries.”
	The Secretary of State did not answer. The public deserve to know if and how much of the money is being paid to the private sector directly. I asked the Secretary of State that question, only to be told:
	“This information is not available in the form requested.”
	Perhaps that reflected the concerns expressed in the NAO report. I asked how much of the £1.8 billion had already been spent; no answer. I asked what the purpose of the money was; no answer.

Justine Greening: The hon. Lady seems to be unaware that the £1.8 billion budget relates to 2015-16. We are not in that financial year yet.

Mary Creagh: A total of £700 million is being spent in one fund over three years, and the Secretary of State is unable to answer a single question asked by ICAI, by the NAO, or by me about where and how that money is being spent. Presumably—as in the case of the huge increase in the funding of PIDG—that is because she does not know. The Public Accounts Committee has now examined PIDG’s investments. Its report will be published tomorrow, and we await it with great interest.

Stephen O'Brien: As I am sure the hon. Lady is aware, the amazing, incredible leadership of the United Kingdom, straddling both parties’ times in office, is much admired around the world. I happen to have just come back from speaking at an event in Davos, where our leadership, through a unity of approach across the House, was greatly admired because of our ability to get things done and our amazing achievements in relation to international development. The coalition Government have been no exception, in that we have always ensured that we include the other side. Is the hon. Lady not as saddened and disappointed as I am by the churlish nature of her motion and the tone that she is adopting? Surely we should act together to deliver the greatest possible public good internationally.

Mary Creagh: I make no apology for demanding transparency when it comes to where the taxpayer’s money is being spent. There is nothing wrong with working with the private sector. These are funds that were set up by a Labour Government. However, when funds are scaled up so quickly without changes being made to governance and oversight, the National Audit Office—not me—is concerned about where and how the money is being spent.

Geoffrey Clifton-Brown: I am sure the hon. Lady agrees that the coalition’s record on delivering the 0.7% of GNI is one of which we should be extremely proud, on behalf of the whole country. If our constituents are to have confidence in that spending, we shall need to see the maximum transparency and value for money. Instead of coming up with a litany of criticisms of my right hon. Friend the Secretary of State—who I think has done a fantastic job—will the hon. Lady answer these questions? If she ever becomes Secretary of State, how many countries will she identify as an aid target, and what level of sign-off will she prescribe for her Department? How many DFID-run projects has she already visited, and how many projects does she expect to visit if and when she becomes Secretary of State?

Mary Creagh: That is very kind. Unlike many Government Members who discovered a new-found interest in development as soon as they were appointed to their roles, I have a long-standing interest in the
	subject. Let us start with my volunteering for Oxfam in Sri Lanka for two months in 1990. Let us move on to my visit to Rwanda and eastern DRC—

Caroline Spelman: On a point of order, Madam Deputy Speaker. The title of the debate is “Sustainable Development Goals”, and Members have come into the Chamber to discuss sustainable development goals. We have heard from the hon. Lady for 15 minutes, with no discussion. A document produced by the Select Committee of which I am a member is tagged to the motion. It is entitled “Agreeing ambitious Sustainable Development Goals in 2015”. Surely, Madam Deputy Speaker, if the hon. Lady had wanted a DFID score card, that is what it should have been called.

Eleanor Laing: I appreciate the right hon. Lady’s frustration, but that was what Mr Speaker would call “not a point of order, but a point of frustration”. The content of the hon. Lady’s speech is not a matter for me, apart from the fact that she must stick to the title of the debate, which, so far, she has done.

Mary Creagh: I am grateful for that ruling, Madam Deputy Speaker.
	I want to respond to the question asked by the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) about the projects that I visited as a Back Bencher. There was the post-genocide work that DFID has been doing in Rwanda. I have visited a Save the Children project in Lubumbashi. I have visited artisanal miners in eastern Congo. I have visited Panzi hospital for the victims of sexual violence—a subject that I know is very close to the heart of the right hon. Member for Putney (Justine Greening). I visited Burundi—a country that is no longer in receipt of DFID funding—in 2009 to look at the Save the Children hospital there. In 2012, I visited Rumbek in South Sudan to look at the work of the World Food Programme, and last week I was in Geneva talking to the World Health Organisation and the Global Fund, UNAIDS and UNITAID. So I do not need any lessons about visits.

Simon Burns: rose—

Kerry McCarthy: rose—

Mary Creagh: I am going to make some progress.
	I want to talk about Labour’s priorities for the sustainable development goals. As I said, health is very important and is the bedrock of all human development. People in rich countries and poor countries alike are affected by disease outbreaks. Strong health systems build resilience. We have seen Ebola in west Africa overwhelm weak health systems, and as the party of the NHS Labour wants others to enjoy the protections we take for granted.

Simon Burns: On the point the hon. Lady was making before this one, how many DFID projects has she visited since her appointment as shadow Secretary of State?

Mary Creagh: I wonder whether the right hon. Gentleman was listening. As I said, unlike the many Members on the Government Benches who have discovered
	a passion for these things in their roles on appointment to the job, I do not need to go on a visit to understand. I have been on those visits that I detailed, and I have been in this role for seven weeks so I hope the right hon. Gentleman will give me some credit for my long-standing interest in this area.
	I will now give way to my hon. Friend the Member for Bristol East (Kerry McCarthy), if she wants to intervene.

Kerry McCarthy: The moment has slightly passed, but when my hon. Friend was listing the projects she has visited I was going to remind her that we also went together to Pakistan after the dreadful earthquake there and saw the relief efforts and the work DFID was doing.

Mary Creagh: I am very grateful to my hon. Friend for that. I certainly remember one of the more hair-raising car rides of my life up to the mountains there and seeing the fantastic work that was being done in those areas.
	I want to talk more generally now about our priorities. Universal health coverage would reduce inequality and would stop 100 million people a year falling into poverty. Figures from the House of Commons Library show that, unfortunately, this Government have cut bilateral spending on health in Sierra Leone and Liberia from £26 million in 2010 to £16 million this year. Four months ago the International Development Committee criticised DFID, saying:
	“The planned termination of further UK funding to the Liberian health sector is especially unwise.”
	Lasting health care systems are about more than the delivery of commodities such as vaccines and bed-nets, vital though they are. Despite the progress made over the last decade, HIV and AIDS continue to blight the lives of millions of people. Between 2008 and 2013, Britain gave £40 million to support the work done by the International AIDS Vaccine Initiative, yet Ministers have slashed that support to £5 million for 2013-18— a massive 87% cut.

Justine Greening: rose—

Mary Creagh: Perhaps the Secretary of State would like to explain why that cut was made?

Justine Greening: I really just wanted to ensure that the record was straight. This Government have spent more on health care in Sierra Leone in every year in government than the hon. Lady’s Government did. I will be specific: DFID’s 2009-10 annual report says Labour spent £11 million on health in Sierra Leone. This Government have consistently spent more than that in every year. Does she regret not spending more previously?

Mary Creagh: Well, my question to the Secretary of State is: does she regret cutting, and is she going to reverse her decision to pull out of bilateral spending in Liberia—yes or no? My figures are from the House of Commons Library, and I do not recognise the one that the Secretary of State has used. I have also joined them together; the combined total was £26 million for Sierra Leone—[Interruption.] Here is the answer, if the Secretary of State will listen and stop chuntering. The combined
	total was £26 million in 2010—
	[
	Interruption.
	]
	It is hard to listen when you are talking, I find. The combined total was £26 million in 2010, and it is £16 million today. That is a £10 million reduction. Perhaps she would like to write to me to set the record straight. We can have an exchange of letters; I am sure it is pretty dull for people to listen to this.
	Ministers have slashed funding for the international AIDS vaccine; there has been a massive 87% cut. That cut is a short-sighted mistake if we are to invest for the long term in tackling those neglected diseases. I note that the Secretary of State neglected to explain why the funding was cut by 90% for that international research programme.
	On human rights, we want women and girls to exercise their human rights free from the fear of violence, coercion and intimidation—

Justine Greening: rose—

Mary Creagh: The Secretary of State will have her chance when she makes her speech.
	We want girls to enjoy their education free from the threat of child or forced marriage. However, Tory MEPs voted against the European Parliament’s report on sustainable development goals and on the section on women’s sexual and reproductive rights. We want to tackle the economic conditions and supply chains that tolerate the obscenity of 168 million child workers. We want to ensure that children affected by conflict have the psycho-social services that they need and the right to go to school. We want members of the lesbian, gay, bisexual, and transgender communities to be free to love and marry whomever they wish. We want the disabled to participate fully in society, and we want protection for indigenous peoples.
	We want workers to enjoy decent work, decent pay and rest breaks, and to have the freedom to join a trade union. We must not have a repeat of the terrible Rana Plaza disaster. We will therefore reverse this Government’s ideological decision to stop funding for the International Labour Organisation.

Caroline Spelman: Will the hon. Lady acknowledge that Members on both sides of the House came together and succeeded in putting into the Modern Slavery Bill—which this Government have enacted—a clause on transparency in supply chains, precisely to deal with the exploitation she describes? Labour Members also supported that measure.

Mary Creagh: Absolutely, and I pay tribute to Members on both sides of the House for that. I believe that that was a Labour amendment, but it had cross-party support and we welcomed that.
	Eradicating poverty will be possible only if we tackle climate change. If we do not keep temperature rises to below 2º C, millions will fall back into poverty. The Prime Minister says very little about his wind turbine these days. He is a prisoner of his divided party, which is split over whether climate change even exists. For Labour, climate change will be at the centre of our foreign policy and integral to our plan to change Britain.
	There is a real opportunity to address climate change this year. The United States, the EU and, most importantly, China, are all showing a willingness to act. At the Paris summit in December, a Labour Government would
	push for global targets for reducing carbon emissions, with regular reviews towards the long-term goal of what the science now tells us is necessary: zero net global emissions in the latter half of this century. In addition, we must ensure that the sustainable development goals have a specific goal on climate change—something that the Secretary of State has repeatedly failed to back.

Richard Benyon: Having stood opposite the hon. Lady at the Dispatch Box, I know that her tone can sometimes be a bit abrasive. I know that she has been in her present role for only seven weeks, but could she not use this opportunity to say that she welcomes some of the things that are going on in relation to international aid, including some of the bilateral arrangements? Does she not welcome the continued spending of 0.7% of gross national income? Does she not agree that there are some good projects? Her tone today has been deeply divisive on an issue on which there has traditionally been great consensus in the House.

Mary Creagh: I am not saying that everything the Department for International Development does is bad; I am trying to point out—[Interruption.] No, that is a wilful misunderstanding of it. On the 0.7%, was the hon. Gentleman one of the Members who stayed here to vote that through? More Labour MPs were in this House for that than Conservatives and Liberals put together, and it would not have passed without Labour votes—and he knows it. The Government have had five years of Government time and Backbench Business Committee business time on a Thursday when nothing has been done.

Stephen Doughty: It is entirely fair for my hon. Friend to be scrutinising and questioning Government policy, particularly on climate change and what position is taken into the sustainable development goals summit. Does she feel that a Prime Minister who said that we should “cut the green crap” is the right person to lead this country into crucial negotiations about climate change and the future of poor countries around this world?

Mary Creagh: I am afraid that the climate issue was used by the Prime Minister. Everyone remembers the hug a husky trip in 2006; I do not know whether that is one of those photos the Tory party attempted to delete from the internet, but yesterday I still managed to find a good few pictures of him doing that. He was certainly less enthusiastic about the issue in government.
	With the right leadership, ours is the generation that can end extreme poverty, reduce inequality and tackle climate change. We can move to a world beyond aid and enable people to secure justice instead of charity. The year 2015 provides a unique opportunity for the world to think bigger and do better for ourselves, our children and the world’s poorest people. That is a thrilling opportunity and we must not let them down.

Justine Greening: In 2000, the international community agreed a simple and powerful set of objectives: nobody should live in extreme poverty; all children, including
	girls, should be in school; and the epidemics of HIV/AIDS and malaria must be tackled. Crucially, part of that was about the desire to work in global partnership to achieve goals by working together. I wish to take this opportunity to thank non-governmental organisations, people in the development community and my staff in DFID, of whom I am exceptionally proud, for all the work that they have done, working together, over the past 15 years.
	In those 15 years since the millennium development goals were agreed, we have seen the greatest reduction of poverty in history. The MDGs inspired the international community to achieve amazing results: extreme poverty was cut in half by 2010, five years ahead of target; there have been visible improvements across all health targets; more than nine in every 10 children worldwide now have a primary education; and we are well on our way to tackling hunger and malnutrition. Of course the MDGs were to run for 15 years, so, as this House will know, 2015 is one of the most important years for the international community in recent memory.

Kate Green: The Secretary of State rightly mentions the progress that has been made under the MDGs across a range of outcomes, including children’s participation in education. Does she agree that one of the great challenges for the 2015 sustainable development goals is to ensure that disabled children, who are often registered for school but do not attend, fully participate in education? How does she see her Government helping to secure that?

Justine Greening: The hon. Lady is absolutely right about that. If we look at the tranche of children who have still not got into education, we see that they tend to be the children who are disabled or who are in more nomadic tribes and it is harder for them to get into education. We are clear that a core ethos underpinning the next development framework needs to be about leaving nobody behind. My Department is pulling together the first ever DFID strategy on how addressing disability should be part of our development programme. So she is right to raise the issue and I can certainly reassure her that this Government have started to bring that issue into our programming more centrally.
	In July, we will convene in Ethiopia to agree a new financing agenda for development. Of course the UK Government have in this Parliament, for the first time ever, finally met their commitment to spend 0.7% of our GNI on international development.
	In September, on the 70th anniversary of the United Nations, we will meet in New York to agree the elements of the post-2015 development framework up to 2030. In December, the world will come together in Paris to agree a binding international treaty to tackle the global dangers of climate change. I am proud to be part of a Government who are taking a leading part in all of those negotiations.
	Let me briefly discuss the post-2015 agenda. The international community has a duty to produce a set of equally inspiring goals and targets to run up to 2030 that will put us on a sustainable development pathway to eradicate extreme poverty within a generation. The UK has played a leading role in that process, not
	least demonstrating our commitment to international development by finally meeting the commitment we made to spend 0.7%. Indeed, that is recognised by the fact that the UN Secretary-General, Ban Ki-moon, personally asked our Prime Minister together with President Johnson Sirleaf of Liberia and the then President Yudhoyono of Indonesia to co-chair the high-level panel of experts who were asked to review these issues and to publish a report about how we should pull together the next sustainable development framework.

Richard Benyon: Does my right hon. Friend also agree that what is important is not just the figure of 0.7%, but how it is spent? What this Government have managed to do is focus the money on where it is most effective. That has required some decisions to be taken. We have had to remove funding from countries that did not need it for those that do.

Justine Greening: We have worked really hard to ensure that we stopped funding programmes in countries such as China and Russia, which no longer require targeted development assistance.

Mary Creagh: The funding to Burundi was also cut. I do not know whether the Secretary of State has visited Burundi, but I have. Does not Burundi need assistance from the Department for International Development?

Justine Greening: Countries such as Burundi do still get support from the UK, but it often takes place through the global funds that we support—funds to support health, education or the work that we do on the humanitarian agenda.

Stephen O'Brien: As the Secretary of State knows, I had some involvement in the decision on Burundi. The shadow Minister cites Burundi. She should be aware that there was a specific project on which we were asked to deliver on a bilateral basis. It was a very effective project, because we delivered to the Office Burundais des Recettes—the inland revenue—so that it could start to mobilise some of its resources to support development. In addition, we enhanced our multilateral aid, which we put through a transparency process. Far from criticising what we did, the shadow Minister should understand that not only did President Nkurunziza and the others in Burundi welcome our approach, but they were particularly grateful that we encouraged the Belgians to step up to fill the bilateral gap. I hope that that is useful information.

Justine Greening: I thank my right hon. Friend for that intervention. He has huge credibility in the international development arena. He has been a Minister, and his work both then and now is hugely valued not just in this country but worldwide. He is absolutely right to say that there were a number of reasons behind the decision on Burundi. Rather than seeing a fact and then drawing her own conclusions, I urge the hon. Lady to dig a little deeper.

Mary Creagh: rose—

Justine Greening: I will give way one last time

Mary Creagh: I thank the right hon. Lady for giving way; she is being very generous. The point about Burundi and other post-conflict countries is that, having a DFID office—or in this case a combined Rwanda-Burundi office—in that country means that it acts not just as a development partner, but a political one in knocking heads together and in dealing with some of the post-conflict factions that still exist in that country. We are talking about withdrawing from that country and only entering it through multilateral assistance. There is nothing wrong with tax assistance. We did all that in Rwanda, and it is an excellent part of development assistance. The point is that if we do not have someone on the ground in the country, we do not have the early warning systems. What happened in Burundi—

Eleanor Laing: Order. The hon. Lady has already made her speech.

Justine Greening: I will make some progress. I will go back to the high-level panel report that the Prime Minister was asked to co-chair by Ban Ki-moon, that was published in May 2013. We all recognise that it played a key role in shaping the broader debate around the sustainable development goals. I am talking about the discussions that it outlined and some of the objectives and challenges that it set out for the new post-2015 framework.

Caroline Spelman: The UK was one of the first countries to identify sustainable development goals as the best idea around for the outcome of the Rio+20 summit. The presence of our Prime Minister on the high-level panel on sustainability and the vision of the UN Secretary-General brought the millennium development goals and the universal sustainable development goals into one entity.

Justine Greening: My right hon. Friend is right, and she speaks from a position of authority. Like my right hon. Friend the Member for Eddisbury (Mr O'Brien), she is well respected, both for her service as a Cabinet Minister and for her tireless work with charities such as Tearfund. She is absolutely right: we were one of the key players that recognised the need to fuse the two agendas, of sustainability and climate change and of tackling poverty, successfully if we were to achieve the goal that my Department works faithfully to achieve of eradicating absolute—

Helen Goodman: Government Members say that they want a bipartisan approach and nowhere is that more useful than on the issue of climate change, because we need a long-term strategy. Why does the right hon. Lady resist having separate climate change goals within the sustainable development framework?

Justine Greening: The hon. Lady is somewhat misinterpreting the Government’s position. If she looks at the report by the high-level panel of experts co-chaired by the Prime Minister, she will see that it includes a range of targets and goals in relation to climate change. I shall come on to that later but, as I have said, no one can deny that the UK has played, continues to play, and will play a leading role in climate change discussions, not least because that flows into the work that we do in international development, for example, setting up the
	international climate fund and investing nearly £4 billion in projects that can help to tackle development and, in many cases, give a real lead in addressing climate change.
	Since the report by the high-level panel, the open working group on sustainable development goals—a group of 70 member states mandated at Rio+20 to deliver a proposal on those goals—the UK has pushed for the highest possible level of ambition. We have been consistent in our drive for member states to agree an inspiring and workable agenda centred on the eradication of extreme poverty, with sustainable development at its core, ensuring, as I said to the hon. Member for Stretford and Urmston (Kate Green), that no one is left behind.
	As part of that, we have consistently argued for a strong health goal that focuses on strengthening health systems and on ensuring effective health outcomes for all women, men, girls and boys at all ages. We have clearly stated that the framework must fully integrate environment and climate change, and it must have a strong goal on gender equality focusing on improving prospects for women and girls. I was disappointed that there was no explicit reference to the importance of having a strong gender goal and the mainstreaming of women and girls’ issues in the development framework. I hope that we can continue, as we have done in the past, to have cross-party consensus on those issues to make progress.

William Cash: I thoroughly endorse what my right hon. Friend has said. I should like to take the opportunity yet again to congratulate her, the Prime Minister and all those involved from all parts of the House in helping to push through the International Development (Gender Equality) Act 2014—something that that she has emphasised but which—and I say this with some regret—was not sufficiently observed by the Opposition spokesperson.

Justine Greening: I am grateful for that intervention. My hon. Friend the Member for Stone (Sir William Cash) has worked tirelessly on gender equality issues. I am proud to have been in a Parliament and part of a Government who supported his Bill on international development and gender equality. I hope and expect that by the end of this Parliament we will have passed not just one Bill on international development introduced by a Conservative MP, but a second Bill introduced by a Liberal Democrat—a coalition effort on two Bills that will make a real difference for the long term.
	We want to see, and the open working group included, the critical issues that the millennium development goals omitted, including peaceful and inclusive societies, economic growth, which is key if we are to increase people’s prosperity, and good governance. Today I shall reflect on the progress that the international community has made to date on agreeing the post-2015 development framework. The proposed sustainable development goals agreed by the open working group last July reflected a high level of ambition and the UK was instrumental in forging that outcome. Those goals have been welcomed by the NGO community, and, like the high level panel report, they rightly devote significant attention to climate change and environmental sustainability.
	The open working group’s gender goal is excellent, with targets on sexual and reproductive health and reproductive rights. Goal 16 on peaceful and inclusive societies and access to justice is especially welcome.

Mary Creagh: rose—

Justine Greening: I give way one last time.

Mary Creagh: The right hon. Lady might have missed my point on human rights, but there was a point on women and girls and child marriage in my speech. She mentioned sustainable development goal 16. Can she explain why her Conservative colleagues in the European Parliament voted against that goal?

Justine Greening: The hon. Lady continues to seek division, which is regrettable.
	Those goals have been welcomed by the NGO community, and the UK Government have said that we support the breadth and the balance of the open working group report. We recognise, though, that the post-2015 framework needs to have the universal appeal that made the MDGs so successful. Developing countries were able to take those goals in their entirety and integrate them directly in their national development plans. The deputy Secretary-General of the UN, Jan Eliasson, said clearly to me the last time we met a couple of months ago when he was in London that that was one of the unintended impacts of the MDGs—countries used them as their development strategy because they felt that they could work with them. That is why the UK has been strongly advocating a shorter, more inspiring and more implementable set of goals and targets that resonates with people around the world. We want to keep the breadth and the balance of the open working group’s goals and targets, but we want to ensure that we get a framework that can truly improve the lives of the poorest people in the poorest countries.
	We know that, for the poorest people in our world, we cannot allow this discussion, process and debate to be kicked around as a political football. We should be steadily building consensus. In December the UN Secretary-General published his synthesis report “The Road to Dignity by 2030”. He called on member states to strive towards the highest level of ambition and he set out six principles that member states should strive towards: dignity, people, prosperity, planet, justice and partnership—working together. He also called on member states to look at targets and to ensure that these are measurable, implementable and in line with the level of ambition that we want to see. I have spoken to the Secretary-General on a number of occasions about the post-2015 framework and about the need to make sure that, like the MDGs, it is compelling and transformative. He is right that these principles must be taken forward in negotiations.
	In his synthesis report the Secretary-General made a clear link between the post-2015 framework and the outcome of the climate change conference in Paris. I agree that the two are fundamentally connected and that 2015 is a unique year and a unique opportunity to bring the two agendas together. As I argued at the UN General Assembly last year, it is the very poorest who will be hit first and hardest by climate change. Our objectives for the Paris meeting are clear and ambitious. We want an outcome that delivers the ultimate goal of the UN framework convention on climate change, which is to avoid dangerous climate change by limiting the global average temperature increase to no more than 2° C above pre-industrial levels. We are one of the few
	countries arguing for this to be explicit in the SDG framework. The most cost-effective and reliable way to achieve that is through an international, legally binding agreement with mitigation commitments for all.
	Our approach to the 2015 framework can support that in two ways. First, it will ensure that climate is truly integrated in, and demonstrably an integral part of, the final framework of goals and targets. Secondly, if we can secure agreement at the September summit, it will help to boost multilateralism ahead of the Paris meeting in December.

Caroline Lucas: I appreciate the tone that the Secretary of State is taking. I want to ask about consistency, because the one thing that I learned when I worked for Oxfam for 10 years was that to have credibility on the global stage, we need to have consistency in our domestic policies. The Environmental Audit Committee inquiry into SDGs found that there is a contradiction in the Government supporting subsidies for fossil fuels while at the same time promoting the climate change agenda. Will she say something about that?

Justine Greening: As the hon. Lady knows, I was happy to give evidence to the Committee, because that is a key part of the SDGs that we need to get right. She will know that within the broader international development agenda we have tightened up our work, including with the World Bank, in terms of the projects that we are prepared to sign off on, so we are not investing in those fossil fuels unless there is no alternative for the poorest countries in the world to be able to get the energy they so desperately need to help them start to move down the road to development.
	The UK Government have one of the proudest records of any development aid donor, both in delivering real results for the poorest people in the poorest countries and in shaping the international consensus around what matters most. Let us consider our record for one moment. We are the first country to reach the 0.7% of GNI spent on aid target—something that we promised to do for many years, and done by this Government. Our Prime Minister led the world, hosting the summit in 2011, supporting the global alliance for vaccines and immunisation, saving the lives of millions of children. Just yesterday, the world agreed to commit a further $7.5 billion to continue the important work of GAVI, or the Global Alliance for Vaccines and Immunisation, from 2016 to 2020. In response to the UK’s pledge of £1 billion, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, said:
	“The UK’s generous pledge to Gavi—which will save around 1.4 million children’s lives by 2020—is another example of how Britain invests in development solutions that provide value for money and real impact. The UK has been instrumental in helping to mobilise the international community to give generously to Gavi. The people of Britain should be proud of their huge contribution in creating a world that is healthier, more stable and increasingly prosperous.”
	I wonder whether he would be confused by the tone that the shadow Minister has taken.

Andrew Mitchell: Would my right hon. Friend like to reflect on the fact that because of the decisions made by the whole of the House of Commons in respect of the GAVI replenishment in 2011, throughout the five years of this Parliament a child will have been
	vaccinated every two seconds and a child’s life saved every two minutes from diseases that none of our children, thank goodness, die from in Britain?

Justine Greening: My right hon. Friend is absolutely right. He will know that in addition, the pledge that we made yesterday has increased our level of support for GAVI even further. The fund is not just able now to deliver vaccination and immunisation for those children; in the case of Ebola it can play a real role in stepping up to help us to combat new emerging diseases and health threats as well, so it has a much broader and more strategic impact on global health security than anyone could possibly have realised when it was being set up. It is also, critically, a model that pulls in the private sector, and allows drugs to get to children in a way that would never have been possible if we had not pulled together those different parties to work for one common goal with countries that have a common strategy on immunisation. It is incredibly important and we will continue to support it.
	Our Prime Minister has led global summits in London—in 2012 on family planning and in 2013 on nutrition and combating stunting. In 2014 I was immensely proud to work with him on the Girl summit, where we catalysed a global movement to eradicate female genital mutilation and early and forced child marriage. It was a pleasure to be able to go back to Walworth academy last week to talk to people there about some of the progress that we have made over the past six months since that conference and the key role that they were able to play in ensuring that it was such a success. That focus on girls’ rights came on top of the global summit that my right hon. Friend the Member for Richmond (Yorks) (Mr Hague), now Leader of the House, organised to prevent sexual violence in conflict.
	We will use this proud record and the credibility it brings us on the world stage to argue unashamedly for a post-2015 development agenda that works as a clear strategy for eradicating poverty, leaving no one behind and achieving sustainable development.

William Cash: On FGM, the Serious Crime Bill has some very important stuff in it. It needs to be improved—as my right hon. Friend knows, I am arguing for that at the moment—but it is a huge step forward, is it not?

Justine Greening: It can be a huge step forward. My hon. Friend is absolutely right to see the broader opportunities in that Bill for enabling us to increase our ability to tackle FGM at home. One of the most important elements of the Girl summit was recognising that we have issues to resolve here in the UK, as well as playing our role internationally in helping other countries to tackle theirs.
	The hon. Member for Wakefield (Mary Creagh) accused the Government of failing to support a stand-alone goal on health. She seems a little befuddled on this point, as her claim is inaccurate. We have supported a stand-alone goal throughout this process. Going back to the high-level panel report, if she looks at goal 4 she will see that it explicitly states that it is to “ensure healthy lives”. That is partly why, under this Government, spending on health in relation to international development, just bilaterally, has risen from £750 million a year when we came into government to about £1.25 billion a year now. We absolutely have invested in this area.
	I should correct the hon. Lady on another matter where she seems to have got her facts mixed up. In a recent interview, she said that spending by the Department on fragile and conflict states has “reduced under this Government”. I have to update the House by saying that that is incorrect. In fact, investment has risen from £1.8 billion in 2009 to £2.8 billion in 2013. On the issue of poverty, where we are talking about matters of life and death, and how we can lift people out of sometimes miserable day-to-day existences, it does not do those people, or the challenges they face, any justice to be kicked about as a political football. If the hon. Lady must engage in what she calls hand-to-hand combat, I ask her at least to get her facts right.
	On a stand-alone goal on climate change, I point to our Prime Minister’s own words:
	“Climate change is one of the most serious threats facing our world. And it is not just a threat to the environment. It is also a threat to our national security, to global security, to poverty eradication and to economic prosperity.”
	In short, climate change is too complex an issue to belong in just one goal; as we have said repeatedly, it needs to be interwoven or mainstreamed throughout the entire post-2015 framework.
	I was only too happy to come to this place to talk about the Government’s record on shaping the sustainable development goals. As I said, I would very much have liked women and girls, and particularly tackling violence against women and girls, to be mentioned explicitly in the motion.

Liz McInnes: rose—

Justine Greening: I will not give way because I need to make progress.
	I know that the hon. Member for Wakefield has still not yet found time to go on any visits to see any international development projects in her role as shadow Secretary of State. As and when she does get a chance to visit some of those DFID projects, I hope she will realise, and agree with me, that putting women and girls at the centre of international development is absolutely the right thing to do.
	Finally, we are proud to be the first G7 Government to have achieved the 0.7% target. We are supporting the Bill on the 0.7% target that is currently passing through Parliament. My hon. Friend the Member for Stone (Sir William Cash) mentioned another international development Act, and I hope that it will be the second such Bill to make it through the House. That has largely been achieved by cross-party agreement on international development. Until now, the main parties have very much worked together to ensure that we can support the world’s poorest and most vulnerable people.
	I regret that, as far as I can make out, cross-party consensus seems to be anathema to the hon. Member for Wakefield. From my experience in my current role, she seems to be doing the exact opposite of what is needed to achieve a successful post-2015 framework. It seems to me that she is picking a fight for the sake of it and, ultimately, putting politics before tackling poverty. I urge her to work constructively with us to build the strongest possible post-2015 development framework.

Tony Baldry: All picking such a fight does is to give support to Poujadists outside Parliament who want to attack international development as a
	concept. We in the House should be united on this issue, not trying to pick fake fights, as the Opposition seem to be doing.

Justine Greening: I agree. I believe that the track record of this Government, led by our Prime Minister, shows our absolute commitment to work with all partners so that later this year the UN can agree the most ambitious, inspiring and workable post-2015 framework that will eradicate extreme poverty once and for all, and put the world on a path to sustainable development. The world watches the UK Parliament, and I very much hope that we can now have a constructive debate with the Labour party about how we can work together—as a Government, and as a Parliament—to achieve that aim.

Several hon. Members: rose—

Eleanor Laing: Order. The House will be aware of the enthusiasm for this debate. To accommodate everyone who wishes to be heard in the short time available, I have to impose a time limit on Back Benchers’ speeches of six minutes.

Tessa Jowell: I have listened with great interest to the opening speeches. I say to the Secretary of State that the purpose of an Opposition day debate is scrutiny, and that she has been just a trifle petulant in somehow doubting the entitlement of the Opposition to question the Government.
	I say that from my experience of working with African Health Ministers, Finance Ministers and non-governmental organisations from around the world. They recognise that a new standard in international development was set by the former Prime Minister, my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), during the early stages of the 1997 Labour Government. The previous Government achieved so much progress that they established the consensus from which we must now move forward, but such consensus arises only from having such opportunities for scrutiny and debate.

Stephen Doughty: rose—

Tessa Jowell: I have only six minutes. I will use that time to make a specific point. The shadow Secretary of State, my hon. Friend the Member for Wakefield (Mary Creagh), dealt very well with the progress that has been made.

Andrew Mitchell: Will the right hon. Lady give way?

Tessa Jowell: I will take one intervention.

Andrew Mitchell: The right hon. Lady is absolutely right to talk about scrutiny, but will she at least give this Government credit for setting up the Independent Commission for Aid Impact and for the transparency initiative? That initiative ushered in a new era of transparency, which was a first not only for a British Department of State, but for any European country.

Tessa Jowell: I of course accept the importance—particularly in this area—of the discipline of transparency and of creating an expectation of it both within Governments and between them in making progress on the delivery of donor aid. That is one of the successes achieved by the millennium development goals. As my hon. Friend the Member for Wakefield has shown, progress has clearly been achieved.
	This is an important moment to take stock, to recognise the huge challenges that remain and to consider the nature of the advocacy that this Parliament will make in the final stages of the UN process, which will conclude in September.
	I will focus, as I said, on one important area that I have pursued with other Members through the auspices of the all-party parliamentary group for conception to age two, which is ensuring that the new sustainable development goals have a focus on early childhood. There is a universal language of childhood. Parents around the world have shared ambitions for their children, but the realisation of those ambitions is impeded by a range of circumstances.
	My hon. Friend the Member for Bury South (Mr Lewis), the former shadow Secretary of State for International Development, asked me to undertake a campaign to secure a focus on early childhood in the next round of sustainable development goals, working through the auspices of the all-party group. Using the model of Sure Start for the world, we sought support from countries around the world to make this issue one of the benchmarks against which investments by donor countries in developing countries should be measured.
	Why is this issue so important? Nearly 50% of African children will be stunted by the time they are five. That is appalling on humanitarian grounds and morally indefensible. Given that six of the 10 fastest growing economies in the world are in Africa, the prospect of continued economic growth is less likely. There must be global investment in developing countries to ensure that their economic potential is realised. Among other interventions, we must ensure that there is maximum benefit from interventions in early childhood.
	I welcome the support of 12,000 people around the world on this issue. I welcome the support of 170 countries, and the support and leadership of UNICEF. I welcome the opportunity we had to present the global petition to Amina Mohammed, Ban Ki-moon’s representative, and to address a representative group of member states at the UN.
	Draft target 4.2 states:
	“By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”.
	I am confident that that will begin to address the intractable inequality faced by children in the poorest countries of the world.
	I sat with mothers in Malawi just over a year ago and listened to them talking about the importance of a pre-school playgroup in a rural hut and the benefits it brought to their children. Any one of us could have heard the same conversation in our constituency.
	Let this House acknowledge that progress, and recognise that sustainable development goals that underline the importance of early intervention will reshape the economies of some of the poorest countries.

Stephen O'Brien: I welcome this debate and am enthusiastic about the opportunity to discuss what should come after the success of the MDGs and SDGs in galvanising the world in this regard. I was naturally saddened by the tone of, and some of the expressions in, the motion, which are unnecessarily divisive. I had not intended to use up any of my six minutes on that point as I do not wish to descend to that level. The right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) was right to say that it is the duty of the Opposition to question the Government—I was an Opposition Front Bencher for 11 years so I understand that—but it is not the Opposition’s duty to adopt a tone that is both churlish and deeply divisive. That was unfortunate and I hope for some reflection after the debate on that unnecessary move.
	The UK carries huge authority because we have delivered practically what people across the House, the nation and indeed internationally have so aspired to for many years. I declare my interests which, as it happens, are all pro bono and go back 35 years since I first started combating malaria. I sit on the board of Liverpool School of Tropical Medicine, I am the global advocate for Roll Back Malaria, the UN and World Health Organisation partnership, and I am the Prime Minister’s envoy to the Sahel. I am in no doubt about how it is critically in this country’s interest—across all political views and none, as well as for the whole international community in an increasingly globalised world—for us all to be totally focused on how to build on the success of the MDGs and the SDGs.
	I am struck by the success of the coalition Government, which does indeed build on some of the work and successes that went before—I am happy to acknowledge that. The Secretary of State and her team have shown an absolute dedication and commitment, as well as a very real practical application to what makes for good results in international development. That includes the whole spectrum, from humanitarian intervention and rapid response to sustainable, resilient and good economic developments.
	As we know, the best way to deliver people out of poverty—the top goal we all want—is to help them have an economic future. They will not have that without good education, with an emphasis on girls. I am proud of the fact that I started the FGM debate in Dakar in 2011, which was then taken forward by my successor. I am glad that has been supported across the House. It was all the more powerful because a bloke was doing it. We should not have divisive debates where one side tries to claim the credit. We were totally united on the issue and it is a deep sadness to me that this debate has been set up in the tone that it has.
	I welcome our authority in the area of international development, which comes not just from practical delivery and the 0.7% of GNI. It has been hard won, because it has been coupled with scrutiny and transparency. Ministers set up the Independent Commission for Aid Impact to be a rod to beat ourselves with. It reports directly to the Select Committee and ensured that the shadow Secretary of State had the ammunition she has used today. Its role is not to attack the whole basis of international development, but to make sure that every single pound we spend of taxpayers’ and constituents’ money is well
	spent and properly targeted. That is why I was happy to put the hon. Lady right on her rather superficial approach to Burundi.
	The Government, with leadership from the Prime Minister and technical ability and fantastic support, are totally committed to this agenda. We have also had some magnificent successes that give people confidence that the money has been well spent. DFID is technically superb and a world leader, and our thought leadership is also driving into the mainstream of thinking about international development. That is all at the service of the one thing that, post-1945, we have all wanted to support—the UN, which is the greatest peace deliverer on the planet. The UN has set the agenda. The Prime Minister has been part of the leadership and significant goals have been proposed on climate change, as well as the economic and human development indices.
	We have had the draft 17 goals from Ban Ki-moon, which will now be debated. It would have been a worthwhile debate today if we could have decided how—through results and trying to set up real responsibility and accountability—we could narrow the focus of those goals so that they become deliverable and we can get them financed by the international community. That is vital, because at the moment there are too many goals and the effort could be too diffuse. We could end up losing some of the successes of the MDGs. That would have been a worthwhile debate, and Ban Ki-moon and our colleagues at the UN would have been deeply impressed had we been able to offer such help. But no, that was not the tone of this debate, sadly.
	Unity of approach has put good governance, security, humanitarian development, resilience and sustainability together as part of a holistic approach, with great NGOs, great technical support from donor nations, finance and an emerging clarity of partnership. That is what I have been doing in the past two and a half years in the Sahel—another pro bono position. As recently as last Tuesday, I was sitting in Niamey in Niger, which is the poorest country in the world. The people there are desperate for food, but what is really important is to make sure we get security right—they are more fearful of Boko Haram coming across the river in the Diffa region. It is therefore much more important to tie security with humanitarian development, good governance and transparency.
	While I was in Davos, it became clear that what the UK thinks was considered instructive. As we move from MDGs to SDGs, it is clear that we have leadership and we should be grateful to this Government for delivering it. I hope that unity will now break out.

Tom Clarke: I welcome the debate and have no difficulty in supporting the motion moved by my right hon. and hon. Friends. I think the House is in danger of being a bit hard on itself. Some very good points have been made already. I have to say, as somebody who has been very interested in international development since I came to the House, I have heard debates that I have found much, much more disturbing than today’s one.
	It is right for the Opposition to use the time available to debate these issues. The Government could be encouraged to give more time to them, if only because it would give
	an airing to the Secretary of State and her ministerial colleagues—that cannot be a bad thing. I want to see more debates of this kind. I cannot join the criticism of my hon. Friend the Member for Wakefield (Mary Creagh) that, after seven weeks in her role, she has not been abroad. My heavens, it is a difficult enough issue to master! For heaven’s sake, let us give the House a bit more time to focus on the issues before us.
	I welcome, in the spirit of the debate, the Government’s achievement of the 0.7% of GNI target. I have said that previously, and I have made no secret of my view that DFID is one of the better Government Departments. However, I believe it is perfectly reasonable for the motion to invite the Government to put before the House a commitment to that target in legislation. That has not happened, and because it has not happened we were able to debate an excellent Bill promoted and guided through Parliament by the right hon. Member for Berwickshire, Roxburgh and Selkirk (Michael Moore). He knows—I served on the Committee and am one of the Bill’s sponsors—that the Bill had my full support. I also supported the excellent Bill promoted by the hon. Member for Stone (Sir William Cash), who is not in his place. I have to say to the Secretary of State—I hope this will not be seen as unduly controversial—that it is not enough to say we have had debates initiated by Back Benchers—through them introducing, rightly, good Bills—without accepting that the Government, too, have a responsibility to introduce transparency on these matters by encouraging debates in the House.
	The Bill from the right hon. Member for Berwickshire, Roxburgh and Selkirk was debated in another place last Friday. I read the debate, which I thought was excellent. It was the kind of discussion I would like to see, and have heard, in this House. I pay tribute, in particular, to the speeches of Baroness Royall, Baroness Williams, Lord Judd, who has great experience with Oxfam, and Baroness Chalker. I shadowed Baroness Chalker, although it was a bit difficult because she was in the House of Lords as the Minister in the Department. Our ability to discuss these matters has improved tremendously, but there is still room for improvement, as the need for today’s motion suggests.
	I would like to pay tribute to my constituents, who have given me great support on the international development issues I have raised over the years. In particular, I pay tribute to Charles Fawcet, a retired teacher, for his work in Malawi, which I shall visit in a few weeks with him. It would be churlish of me not to thank DFID, particularly its office in East Kilbride, and the Secretary of State for the support they have given to Charles and his team as they have built up relationships between my town of Coatbridge and the people of Malawi. I hope to see some of that work when I am there.
	I recognise that not everything I am saying is popular. I received some awful e-mails after the Third Reading of the Bill introduced by the right hon. Member for Berwickshire, Roxburgh and Selkirk. One came from a man in Harrogate who challenged me to defend our giving money to India. I urge the Government to take a role in development education. Does this man really believe—it might comfort Conservative Members that he plans to vote for UKIP—that the starving children and the people dying of tuberculosis whom I saw when
	I last visited India had the slightest input into the decision of their Government to send rockets into space? Of course, they did not, and they should not be punished for their own poverty.
	I am proud of the efforts of the Scottish Catholic International Aid Fund and the Catholic Agency For Overseas Development—I am chair of the all-party parliamentary friends of CAFOD group—but a lot more has to be done, particularly on climate change. It is right that we address this challenge, and I am glad we are doing that in this debate.

Malcolm Bruce: I am pleased to follow the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who has a long and distinguished record of championing development issues and was the author of important legislation in this field.
	I welcome this debate. In a year when momentous decisions have to be taken on international development, it is important to have such a debate. However, I am disappointed by the tone and terms of the motion. I have had the honour to chair the International Development Committee for nearly 10 years, in opposition and government, and during the tenure of four different Secretaries of State. I have never feared our being critical of Governments so long as our criticisms are constructive, evidence based and designed to improve the quality of our aid delivery and to probe how effectively it can be delivered. That is the tone in which we most assuredly deliver the best outcomes.
	Many people, including representatives of donor Governments who have not achieved the 0.7% target, ask me how we have managed to do it. I say, “It’s quite simple. The overriding reason has been cross-party consensus”. The suggestion, therefore, that the Labour party might now break that consensus is deeply disappointing, and it should reflect on the implications. The motion criticises the Government for not having legislated on the 0.7% target, but only one country, Belgium, has done so; there is no requirement to do so; and, most importantly, we have actually delivered the target—0.71% in fact. Having said that, I am pleased that the Bill introduced by my right hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (Michael Moore) is well on the way to completion, with Government support. Yes, of course it could have been done by the Government, and I wish it had been, but that is not a point of substance, because it is happening thanks to cross-party support.
	The motion also criticises aspects of the SDGs, which, like the Secretary of State, I do not actually understand. We have 17 draft goals and 169 supporting resolutions, which is clearly unmanageable. It has to be boiled down to something that people can work with and remember. Ban Ki-moon has got his own six essential elements, for which I think he is seeking support. The Secretary of State or the Minister might want to say where the Government stand on that, although I imagine that we will want to be constructive and work with the United Nations. After all, it is the United Nations that to a substantial degree has ownership, although we are all members of the United Nations and Britain is a particularly important member. I think Ban Ki-moon understands, as we do, that having a plethora of goals dilutes them to the point where nobody can remember them.
	Those six points—which I am sure will receive support—encapsulate the very essence of what is being criticised in today’s motion. There is a commitment on health and a commitment on climate change—they are central to those six overriding sustainable development goals. What we should be doing is working to get the maximum international consensus for a set of goals that are understandable and transparent and that enable all those commitments to be delivered in terms that will make a difference, which means ending absolute poverty by 2030 and leaving no one behind. Surely we are all agreed about that.
	I believe that is where we should go. In addition, I am particularly pleased that the hon. Member for Wakefield (Mary Creagh) referred specifically to women and girls and disability, two things that have been particularly championed by the present Government—I am not saying they were not championed by the previous Government, but they have been taken forward. I pay tribute to the Secretary of State and her former colleague as Under-Secretary, my right hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone), who took those causes up and championed them with her brand of campaigning enthusiasm.
	That has made a difference, not just here and in our policy, but globally and internationally, because the thing I have found in the 10 years that I have had the privilege of doing this job in the House is that the UK gives huge leadership, not just through the volume of what we do, but through the quality of the way we do it. I know that there is an election coming up in May, but there are people outside who want to discredit and destroy our commitment on international development. I would plead with Members to recognise that what will ensure that it is delivered is for us to stay together in our commitments and to ensure that our criticisms are constructive and designed to improve the outcome and make sure that what we do actually makes a difference.
	As for the final criticism—of the engagement of the private sector—in reality, unless people can gain livelihoods and employment that will enable them ultimately to pay taxes and fund social services, health care and education, the countries we are supporting will never get out of poverty. The question is: what is the role of the private sector, what is the role of the donors and how do they work together? The questions we have heard are perfectly legitimate—let me be clear about that—but the implication behind them is that, somehow or other, DFID is doing the wrong thing by pursuing that agenda, and I could not agree less.
	The Committee has taken evidence from the Secretary of State this afternoon; we will publish a report that will give our view on this issue in due course. We will also publish a report next week on the future of aid, giving real challenges to DFID, but ones that are based on evidence and that I hope all parties in the House will support, so that we can continue to lead the world on the quality of development that we deliver.

Several hon. Members: rose—

Eleanor Laing: Order. I am afraid that I have to reduce the time limit for speeches to five minutes.

Fiona O'Donnell: It is a pleasure to follow the Chair of the International Development Committee, of which I am a member, although I think he made the cheapest political jibe of the day. However, I will not pursue that any further; I will speak to him about it another time. I would rather pay tribute to the work he has done in this place. He will be a huge loss —we will lose his experience, his commitment and his generosity in working with new members of the Committee —but I am sure he will continue to make a contribution in some other way, because it will be too much of a loss otherwise.
	I am surprised at the sensitivity about looking at the hard politics that exist—and they do—in aid and development. That does not mean that there are not times when we can work together and agree. People may have problems with tone—I am pleased to say that the present Secretary of State has a very different tone from her predecessor—but we should not be put off talking about the substance and the different choices that we make. In the case of the right hon. Member for Eddisbury (Mr O'Brien), although it is not a declarable interest, I would like to say that we are both patrons of Malaria No More. I am pleased and honoured to work with him in this area, but that does not mean that we cannot raise questions. Why do we think it is okay to have the Independent Commission for Aid Impact give the Department green, amber or red ratings, but not for us to talk about its performance in this Chamber and have the same open debate? I really do not understand that, so I deeply disagree with the right hon. Member for Banbury (Sir Tony Baldry), who is not in place at the moment. I think the public become more sceptical if we do not debate this issue enough and we do not have the open debate we need. There is nothing to fear from that; otherwise, it looks like we are being terribly precious about this issue, and that we think the public could not cope with knowing that there are risks with international development. My goodness, the gains are so much greater; it is worth taking those risks. It is often a dangerous and difficult environment for a Department to work in.
	It is right that the Secretary of State has provided great leadership on the issue of women and girls. I pay tribute to her for that, but I would like to see different choices and other areas in which the Department could take a lead. I hope that the next Government—hopefully a Labour Government—will be able to make those decisions. I hope that dealing with malaria will have priority, because for every minute that each speaker is on their feet in this debate, a child dies of malaria. It is an entirely preventable disease that has killed more people in the history of our planet than any other.

Pamela Nash: Will my hon. Friend give way?

Fiona O'Donnell: I am not taking any interventions; I do not want to take time away from other contributors—I am practically a saint, Madam Deputy Speaker.
	I would like to see both Front-Bench teams—I am treating them fairly and equally sceptically—making a commitment to at least maintain the investment for dealing with malaria. We know that the minute we take our foot off the gas, as the Americans say, we see a
	resurgence of the disease. We have seen with Ebola the knock-on effects of people not seeking treatment. That would be desperately sad. As Bill Gates said, when we had the honour of him coming to speak in the Palace of Westminster recently, we are now at the point of developing a toolkit that would allow us to eradicate malaria. That is the language I would like us to start using when we talk about malaria. I would like the UK to take the lead and say that the world’s ambition should be to eradicate malaria. We need to look at the progress made as a great story, with both UK Governments taking a lead in investment and contributing to halving the number of children who die of malaria.
	That is the leadership I want to see on malaria because, as Bill Gates said, we have eradicated smallpox and are close to eradicating polio. We need to raise our ambition on malaria. This is not just about health; it is about the well-being of children and access to education. The World Health Organisation recently showed that 198 million people are currently missing out on either education or employment because of malaria. We need to think about the futures of these children. Departments should be pursuing economic growth for all these agendas. That is my plea to both Front-Bench teams today. I am grateful for the House’s attention.

Nick Herbert: I am proud to serve as co-chairman of the all-party parliamentary group on global tuberculosis, which was established as a cross-party committee in 2005, after a group of Members went to see the problems of dealing with tuberculosis in Kenya and were immensely struck both by the then failure to get on top of a disease that had resurged globally and by the inadequate attention paid to this disease in our national discourse. Since then, our parliamentary group has worked to increase the profile of this terrible disease, which still kills 1.5 million people a year worldwide—entirely unnecessarily when this disease is, in the main, easily treatable and curable.
	It is striking to reflect that TB was declared a global emergency two decades ago and that since then 25 million lives have been lost. However important our efforts to tackle Ebola—I fully support them and welcome DFID’s work in that respect and the sacrifice that many are making in doing so—we should note that TB kills as many people every two days as Ebola has so far killed in total. We have to make sure that we have a focus on this disease, while maintaining focus on the need to beat old diseases that pose a new threat today.
	Yes, there have been successes. New cases have fallen sufficiently to meet the millennium development goal target, and deaths have nearly halved since 1990, but there are still 9 million new cases of TB globally every year. The number of new cases in central Asia, Africa and eastern Europe is not declining, and that is of particular concern. Moreover, we should note that the decline in new cases globally is only 1.5% a year. At the current rate, it will take us two centuries to beat the disease.
	When the west got on top of TB, the annual decline was 10 percentage points a year. That tells us that unless we accelerate efforts to tackle the disease, we shall face a huge loss of life over the next 200 years, and we shall also face the growing costs of dealing with the disease.
	One of the reasons for that rise in costs is drug resistance. Drug-resistant TB is caused by the fact that we have drugs that are 60 years old. We have old-fashioned antibiotics. Nor do we have a proper vaccine for TB, although many believe that we do. As a consequence, we are seeing the emergence of a lethal form of TB that is 450 times as expensive to treat. It is worrying that less than a quarter of drug-resistant cases of TB are detected, and only half are successfully treated. The Prime Minister’s anti-microbial resistance commission, which was established last July, has warned that a failure to tackle drug resistance could mean 10 million deaths from all diseases by 2050, and that, crucially, that would reduce world GDP by two to three and a half percentage points by 2050. All those facts make the case for more action now.

Pamela Nash: The right hon. Gentleman is making a powerful speech, and I agree with what he is saying, but is he as disappointed as I am that the Government have not committed themselves to the widely supported target of ending AIDS, TB and malaria by 2030?

Nick Herbert: No. I was about to say that the Government’s response has been superb. They have just committed £1 billion to replenish the global fund, which is one of the biggest commitments that have been made. Eighty per cent. of all the world’s funding to fight TB is channelled through the fund, and as a result 12.3 million TB sufferers have been tested and treated so far. However, it should be recognised, in the context of the overall programme for tackling TB and the World Health Organisation’s target of ending TB by 2035, that there is a 2 billion annual shortfall. That is not the responsibility of the United Kingdom. There is a global shortfall amounting to a quarter of the resources that we need to beat this disease.
	Let me urge two courses of action. First, we need to focus in the sustainable development goals on diseases that we can beat—TB, HIV and malaria—and on an explicit target to beat them. Secondly, we should step up our research and development effort to combat TB. We are at a tipping point: there is an opportunity, and there is a threat. The opportunity is the availability of new technology, which could enable us to beat TB within a generation. The threat is drug resistance, along with inadequate funding and insufficient efforts to combat the disease. That could mean an awful lot of cost and human suffering in future.DFID is the world’s best funder of research and development, and, given its fantastic leadership position, it could convene an international effort to step up research and development to beat TB.
	I am proud to have led the formation of a global TB caucus last year, when 170 Members of Parliament from five continents came together to urge stronger action to tackle this disease. The success of our Committee and the caucus has been due to their cross-party nature, and the fact that they have operated on the basis of consensus. That tone was sadly lacking in the ill-judged speech of the hon. Member for Wakefield (Mary Creagh).

Nia Griffith: I am grateful for the opportunity to contribute to the debate.
	Although there is cross-party agreement on much of the United Kingdom’s aid programme, it is perfectly proper for all of us to ask questions, raise concerns and
	demand evaluation, in order to ensure that the taxpayer’s money is spent transparently and wisely and we secure the best possible value for money in the outcomes that it produces. Those are genuine concerns that our constituents have raised with us. The more certain DFID can be that money is not going astray—and, moreover, can demonstrate to the British public that that is the case—the better.
	I congratulate the right hon. Member for Berwickshire, Roxburgh and Selkirk (Michael Moore) on introducing his Bill, but it was chance that his name came up in the ballot and he chose that topic. It is a shame that it was left to chance, rather than being brought forward by the two Government parties, both of which had promised such a Bill in their manifestos.
	Clearly, 2015 is a historic year for international development. It is a time when we will be talking about both the sustainable development goals and climate change, on two very important occasions in September and December of this year, and I want to see the UK really taking a lead, as we have done in the past. I certainly do not want us to be backtracking on anything to do with climate change, which I see as one of the most important issues. It is directly linked to international development. It is blatantly clear to us that while we have enjoyed economic development and have created many of the climate change issues, it is people in developing countries who are suffering the consequences;, and it will be they who suffer drought and flooding if the temperature rises and they who will have the least resilience. It is very important therefore that we help those countries to build the necessary resilience and that we recognise the importance of tackling climate change and raise it at every possible opportunity. We know perfectly well that our tackling it here is not enough; it needs to be done on an international scale.
	It is important that we get value for money, so will the Secretary of State tell us exactly what she is going to do to tackle the issues raised in the National Audit Office report on the funding of the Private Infrastructure Development Group? The report said the Department
	“lacks sufficiently robust information to demonstrate that investment in PIDG is the best option”,
	and its financial control has been lacking. Likewise, please will she tell us what she is going to do about the concern that was raised about TradeMark Southern Africa—about petty cash and so forth—as that is important?
	The Ebola crisis is ongoing, and it is too early for us to say what might not have been done as well as it could have been. I want to praise the efforts of all who have been involved and pay tribute to the sacrifice that many of them have made to help people, but concerns were raised in the evidence given to the Public Accounts Committee, and in what we saw on our TV screens, with Save the Children suggesting that perhaps there was not sufficient experience there. What can be done in future to identify people who would be able to help in such circumstances—people who would be able to go and help build the infrastructure, because it was a case of starting from zero? Can we make sure that if such people are identified they can be released to help, perhaps in the way that happens with reservist forces?
	It also appears that not having direct flights has hindered some of the aid organisations and has increased costs. I would have thought it would be easier to identify planes coming in from Sierra Leone, for example, than
	having people change planes somewhere else and it being less easy to identify who is coming back from Sierra Leone.
	The issue of human rights is fundamental to the SDGs. I congratulate the hon. Member for Stone (Sir William Cash) on his International Development (Gender Equality) Act 2014, but we know that rights and empowerment are often hard-won and easily eroded, so we can never be complacent. While there have been strides forward in getting more girls into school and raising the issue of violence against girls and women, there are still huge challenges.
	Likewise, we need to do more to safeguard the rights of people in the lesbian, gay, bisexual and transgender communities and of people who have disabilities. It is also important that we should promote the right to join a trade union, just as we talk about self-sufficiency and sustainability in terms of economic development and good governance. With these rights too, empowerment and training are vital, and it is regrettable that the Government have withdrawn funding for the International Labour Organisation, which I would like restored as soon as possible.

Michael Moore: It is a pleasure to follow the hon. Member for Llanelli (Nia Griffith). I welcome the fact that the Opposition have brought forward this debate, if not the particular motion. This is an important subject, and I agree with them that it is regrettable that there is not more opportunity in Government time to debate these important matters. However, I really regret the tone in which the hon. Member for Wakefield (Mary Creagh) chose to introduce the debate. She disregarded the consensus that has existed on this subject over a number of years, and I am really surprised that she did so; it was like a hackneyed replay of the playbook that we saw before the last general election.
	When the draft Bill to enshrine the spending of 0.7% of our GDP on the United Nations target for official development assistance was introduced, it was clear that it was intended to create a dividing line between the then Labour Government and the Conservative Opposition. I give credit to my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) for the rather nifty piece of footwork that he employed in committing the Opposition to supporting it. It was easy for me, as the Liberal Democrat spokesperson, to make that commitment. The Bill therefore had cross-party support.
	In the past, I have credited the Labour Government with the fact that they started the debate and set the track for us to follow in getting to the 0.7% target. However, there was no hint today of Labour acknowledging that leadership and welcoming everyone else into the fold; it was Labour, Labour, Labour and nothing else. I think that people outside this place will judge us harshly if this hard-won consensus cannot be seen to hold. They would have gained no impression at all from the hon. Member for Wakefield that we had even reached the 0.7% target under the coalition, on the back of the work that the previous Labour Government did.
	I set all that out on Second Reading of my private Member’s Bill and on every subsequent occasion. It was my great good fortune to come second in the ballot and
	to introduce that piece of legislation. Until today, I also regarded it as my great good fortune to have such clear cross-party support, rather than the point scoring that we have now seen. If Labour had wanted to claim leadership on this, it had the chance in government to bring such legislation forward, but it did not actually do it, so Labour Members should not criticise the coalition for not having done it in Government time.
	On the point about Labour MPs delivering on this, I must say that they were here in numbers during the passage of my Bill. I am grateful to every last one of them who was here in the Chamber and who voted on all its different stages. Six people voted against it on Second Reading. Seven voted against the money resolution and five voted against it on Third Reading. Any one of the parties on this side delivered more votes than was required. Labour Members were critical of closure motions, but please let us recognise that the passage of the Bill in this place was a joint enterprise.

Tom Clarke: The right hon. Gentleman knows that I supported his Bill all the way. If I may say so, he seems unusually proactive this afternoon, but perhaps if he calms down he will acknowledge that the fact that some people—albeit a minority—tried to talk out his Bill on Third Reading shows that there is a case for more development education, starting in this House.

Michael Moore: I apologise for surprising the right hon. Gentleman with my tone. I do not want to say that the Opposition started it, but there really is a different kind of tone to the debate today. I thank him for his contribution to the Bill, and for his own track record as a Minister and in piloting the earlier legislation through. He is right to draw attention to the nay-sayers, who I must point out opposed the Bill from both sides of the Chamber—

Stephen O'Brien: It was Lord Lipsey who opposed it. Labour!

Michael Moore: None of them is in the Chamber this afternoon; that is the important point.
	The point is that we have now, happily, got the Bill into another place, and I want to pay tribute to my great friend the noble Lord Purvis who is piloting it there. There were two speeches against it on Friday—one from a Conservative peer and one from a Labour peer—so let us please put this nonsense behind us. It is entirely legitimate to scrutinise legislation in that way. It is entirely fair of the hon. Member for Wakefield to ask challenging questions of the Secretary of State, and it is entirely fair of the hon. Member for Llanelli to add to that list of questions. Let us have more time to debate and scrutinise, just as the International Development Committee, chaired by my right hon. Friend the Member for Gordon (Sir Malcolm Bruce), has done, with cross-party support, and just as the Independent Commission for Aid Impact is doing within the Department. All those things matter, because outside this Chamber the consensus is not as wholehearted as we believe it to be. It is therefore important that we can show what aid is for and show that we, as custodians of taxpayers’ money, are looking after that money properly. We have a proud
	position in the United Kingdom. We can claim international leadership in this regard, but it is a joint endeavour; let us not squander it.

Stephen Doughty: Given some of the comments made in this debate, may I begin by saying that I firmly believe there are sincere individuals on both sides of this House who have track records of commitment and of speaking in this House on these issues? However, it is fair to raise sceptical questions, and some of the glossing over of history we have heard is a little rich coming from Government Members. May I gently mention the comments made by the right hon. Member for Berwickshire, Roxburgh and Selkirk (Michael Moore)? I strongly welcome his effort in bringing in his Bill, but to say that the last Labour Government put this down as a dividing line is very unfair.
	I was an adviser in the Department at the time and was very involved with the drafting of our draft Bill. I can tell him with all sincerity that it was brought forward, first, to show leadership and, secondly, to lock in the commitment that the right hon. Member for Sutton Coldfield (Mr Mitchell) later gave. We had reasonable scepticism about what a possible incoming Government might do, given some comments about international development aid that we hear from Members who are not in the Chamber today, and given the record of previous Conservative Governments in slashing DFID’s budget. Every time they had come to office previously, they had merged it back into the Foreign Office, so it was perfectly reasonable for us to set that down.
	I welcome the fact that the right hon. Member for Berwickshire, Roxburgh and Selkirk introduced his Bill and I welcomed his commitment in opposition, too. I also welcome the Government’s support for his Bill—or at least some Conservative and Liberal MPs came to support it as it went through. But it is a bit rich to gloss over things. The last Government’s leadership took the aid budget to where it was and set up DFID, and it is important to put that on the record.

Michael Moore: I wish the hon. Gentleman would not accuse people of “glossing over” things. I invite him to look back at any of the speeches I made, particularly the one on Second Reading, where I laid out, in terms, the Labour party’s record on this issue. I remind him that half a dozen people opposed the Bill, and he needs to be careful what he is suggesting.

Stephen Doughty: I am not accusing the right hon. Gentleman; I was accusing some in this House today of glossing over Labour’s record on these issues. Indeed, I have previously welcomed what he did.
	Let me deal with the sustainable development goals, the main subject of the debate. It is important that we get back to the base principles. It is in our fundamental common interest, as well as being a moral imperative, to get the sustainable development goals right and to continue to make the case for development in this House. Fundamentally, it is a moral case that everyone is born the same and deserves the same opportunity. People in this country and the world over, including in my constituency—where I regularly have difficult debates on the doorstep about this—are not insulated from the consequences of poverty, conflict and climate change in
	other countries. We may see that in shifts in migration—we have all seen the terribly tragic events that are repeatedly happening in the Mediterranean; in poverty-driven conflict creating further zones of instability around the world, which can then lead to the risk of young people, including from my constituency, being dragged into fighting for organisations such as ISIS or al-Shabaab; and in terms of disease, as we have all seen with the tragic circumstances of Ebola in west Africa and the consequences of people then travelling around the world.

Mark Lazarowicz: This is about the tragedy of the Mediterranean. I do not blame the Secretary of State for this situation, but tomorrow it is one year to the day since the House of Commons voted to support the Syrian refugee programme, and as of now there are only 90 Syrian refugees in the UK. Is that not shameful? Let us hope the Government will still, even at this stage, reconsider.

Stephen Doughty: I thank my hon. Friend for the point he makes. I have met many Syrian refugees in my constituency and they come with some truly harrowing tales of what they left behind.
	We need not only to guard against the risks but to consider the opportunities of fairer trade, which would benefit this country and developing countries. I am glad to say that many organisations and individuals in my constituency recognise that fact, and do some incredible campaigning work to raise these issues locally and put the pressure on internationally, too. I am thinking of organisations such as the Penarth and District Lesotho Trust, of which I am proud to be a patron. It has been operating for 10 years, supporting a schools and churches link with Teyateyaneng in Lesotho, and supporting a school, a library and other community work there; there are strong links with the local schools of St Cyres and Stanwell in my constituency. The Penarth fair trade forum has set up a local fair trade business directory, has gained the support of the town council, does fundraising and has held fair trade fashion shows. Indeed, last year it had a fair trade public speaking competition for local schools on the question, “Is fair trade a load of bananas?” That sort of work, bringing in the younger generation, enables the pressure to be built up and the consensus to be developed.
	I also wish to pay tribute to the diaspora communities in my constituency, particularly those from Somaliland and Yemen, who do incredible work in fundraising for crucial development projects back in their home countries. I have been to a number of events where such fundraising has taken place. Those communities provide incredible support in terms of their remittances. They are also involved in fundraising for places such as Gaza which are facing humanitarian crises. Incredible work is done locally in raising funds for Islamic Relief.
	I also praise the Welsh Labour Government for setting up the Wales for Africa programme, which encourages community links and the mutual understanding that fundamentally changes the simplistic view that we should not be helping people overseas and that charity begins at home. It recognises that we are all interdependent and that what happens overseas matters to our own communities.
	Let me turn briefly to a false dichotomy that I often hear in this House. It is the idea that there is clash between supporting development and supporting defence.
	I am very clear that there can be no development without security and, equally, no security without development. I mentioned Yemen and Somaliland, which provide us with some interesting examples in that regard. Yemen is a country with which we have historical ties. We also have a strong diaspora in this country, including in my own constituency. It is also one of the poorest countries in the middle east, and far too often it has been overlooked and forgotten by the international community. I know that this Government and the previous Labour Government made commitments to Yemen and have taken a strong interest in the country. None the less, I question whether we are doing enough. Yemen is now descending into chaos, with al-Qaeda affiliates and others now in the country. It is a prime example of a country that matters.
	The opposite has happened in Somaliland, in which the right hon. Member for Banbury (Sir Tony Baldry) takes a great deal of interest. Investment in development, in increasing democracy and in action to prevent the spread of extremism by groups such as al-Shabab has led to great strides forward for its population. There is the more fundamental question about the recognition of Somaliland. I firmly believe that we need to listen to its citizens in that regard. These examples show why development matters, why we need to continue to consider these issues, and why we need to ensure that they are at the heart of the sustainable development goals.
	This is a crucial year. As you said, Mr Speaker, there are a number of anniversaries in 2015. They include the 10th anniversary of the Make Poverty History movement and that incredible march in Edinburgh. I hope that we will all go forward with the same vigour and spirit in trying to achieve success at those summits.

Tony Baldry: In 1983, shortly after being elected to this House, I went with an all-party team to Ethiopia to witness a famine of almost biblical proportions. Over the past 30 years, Parliament has moved considerably when it comes to all-party consensus on supporting the need to invest in international development. It is also fair to observe that throughout those 30 years, under Governments of different dispensations—for a time, I was Foreign Office Minister with responsibility for overseas development aid—we always had an aspiration to use 0.7% of our GDP to fund overseas development, but not until this Government has that been achieved. In both 2013 and 2014, we reached that target, and we were one of the few leading economies in the world to do so.
	Like other Members, I am disappointed that we have had to have this debate in these terms. It must have been difficult for the hon. Member for Wakefield (Mary Creagh) to take up a Front-Bench brief so near to a general election, and I can understand her wanting to make her mark. However, it would have been perfectly possible for the usual channels and the two Front-Bench teams to have produced a motion for today’s debate on which we could all agree.
	As everyone who has taken a close interest in international development issues will know—as indeed you, Mr Speaker, will know, because we served together on the International Development Committee—there are more critics of international development outside the House than inside
	it. One only has to look at the editorials of some of our national newspapers to see continuing criticism of our spending funds on international development. We should be totally up front about our position. We should explain not only that it is morally indefensible that billions of people in the world are living in grinding poverty on less than $1 a day, but that it is in our national interests that we support international development. We should be proud, collectively and on both sides of the House, of what we have achieved.
	With all due respect to the shadow Minister, all those who listened to her speech—and all those who read it in Hansard—will have got the impression that she was slightly spoiling for a fight because she needed to find something to disagree about. When it comes down to it, one report by the National Audit Office does not add up to any policy differences.
	We should focus on the sustainable development goals, which the Prime Minister has played a big part in leading—he co-chaired the UN Secretary-General’s high-level panel on post-2015 goals together with the President of Sierra Leone and the former President of Indonesia. It is absolutely right that the basic concept should be of no one being left behind: we must make it clear that no goals or targets are considered achieved unless they are met by all relevant economic and social groups. It is important that the social development goals are clear, concise, relevant and communicable. We should not have too many goals. Sometimes, there are so many goals that people forget what they are and they get lost.

Stephen O'Brien: My right hon. Friend will be aware that the proposals from the panel the Prime Minister co-chaired included 12 universal goals and national targets, which have been taken forward in the brief that Ban Ki-Moon issued six months later. My right hon. Friend will be aware, given the point that has been made by the Opposition, that three or four of those goals refer specifically to energy and climate change. As a Minister, I was privileged to support Ban Ki-moon in the conference that he convened on energy support for renewables in the developing market.

Tony Baldry: I would hope that no one in the House believes that tackling climate change is not important. It is important that the sustainable development goals give priority to environmental sustainability to tackle climate change—that is an essential prerequisite of poverty eradication—and go on to deal with issues such as disaster risk reduction, water and food security, and nutrition. All of those are tied up with climate change. The House should not spend time being concerned about climate change deniers—we have moved on from that.
	The sustainable development goals highlight aspects of governance that the millennium development goals left out. If we go back to the heady days of 2000, it was a frabjous time when the whole international community came together. There was a feeling that just by announcing millennium development goals they would happen but, as we have seen, there are still issues with transparency, corruption, the rule of law, property rights, peace and security, all of which are important.
	The hon. Member for Cardiff South and Penarth (Stephen Doughty) and I are both officers of the all-party group for Somaliland and Somalia. Earlier this year, the
	Foreign Office allowed me to go to Mogadishu for a single day—it was a very long day visit—because security is so bad in Somalia that that was all that I was permitted to do. Two days after I returned, there was a mortar attack on the presidential house in Mogadishu, in which, sadly, a number of people were killed. It is incredibly difficult—how does one manage a country that has been undermined by terrorists and insurgents? Likewise, when I went to Juba last year—how does one run country that is locked in civil war? So it is absolutely right that the sustainable development goals are going to focus on issues such as corruption, transparency and trying to bring security.

Mr Speaker: Order.

Tony Baldry: Sorry, I hope—

Mr Speaker: We got the gist of a speech advanced with eloquence and passion. We are grateful to the right hon. Gentleman. I call Joan Walley.

Joan Walley: I will be brief. A report by the Environmental Audit Committee is tagged to this debate, and we hope it will inform the discussion and that Members will look at our detailed conclusions.
	I welcome today’s debate and agree that we should enshrine in legislation the goal of 0.7%, irrespective of whether or not it has been agreed. The point I want to emphasise is that previously in the millennium development goals, insufficient attention was paid to environmental protection and sustainable development. In this year of opportunity, we must make sure that we in the UK and the European Union show the necessary leadership to get to where we need to be at the Paris negotiations with the climate change targets, and at the New York summit with the sustainable development goals.
	Looking back at previous work on sustainability and initiatives such as local agenda 21, I feel that we do not yet have the mechanism across civil society, Parliament, Government and business to make sure that the objectives we all seek are not seen as merely academic, but are translated into policy in both developed and developing countries. The sustainable development goals are important for the UK, so that we do as we say and say as we do, giving us the integrity to lead by example.
	Just as the International Development Committee and the European Scrutiny Committee are scrutinising the sustainable development goals, so did the Environmental Audit Committee. I noted with interest the letter that came through on 8 January in response to the European Scrutiny Committee report, which said that it is important to achieve
	“a final framework of goals and targets that is simple, inspiring and workable while retaining the breadth and balance of the 17 goals”.
	We must not water down those 17 goals. There are risks in watering them down if that means less emphasis on sustainable development. I hope the Minister will address that when he responds.
	I note that in the same response the Government speak about the eradication of extreme poverty, but we must give the same amount of policy attention to the need to reduce inequalities. We must deal with sustainable
	development as well as inequalities internationally on the world stage and in our constituencies. I heard what my right hon. Friend the Member for Dulwich and West Norwood (Dame Tessa Jowell) said about children and the best start ever. As much as we do internationally, we must do at home. Tomorrow I am hosting a working group with the Royal College of Speech and Language Therapists so that children in Stoke-on-Trent have the best possible start.
	All these issues are important. I hope that in his reply the Minister will tell us a little about the climate change aspects and how we will ensure that that is embedded in all the sustainable development goals. I hope he can tell us how the green thread of environmental sustainability will similarly be embedded in those goals. I hope he will tell us how we will deal with the issues nationally. We have heard a lot about international development, but this is just as much a matter for the Treasury, the Department for Environment, Food and Rural Affairs, the Cabinet Office and the Office for National Statistics, because we will need to monitor and audit the implementation of the sustainable development goals that we want to see agreed in New York.
	Finally, this is about future generations—our children and grandchildren. We must do everything possible to communicate this policy through education for sustainable development, so that graduates are equipped by their training to apply the principles of sustainable development to the outcomes that we want from the sustainable development goals to be agreed in New York this year.

Heather Wheeler: This has been a long debate. I would not say that the tone of it has been edifying or that the content of some of the speeches has added to the great words in Hansard for generations to come. Perhaps now, as we near the end of the debate, we can get on to some of the positives that four and three quarter years of this Parliament have been about. It has been about reaching the 0.7% goal. That is a huge achievement. It has been about guiding the private Member’s Bill through so that it will be enshrined in law. That is an amazing achievement that has not been done in 13 years or in four years. We are getting there. Those things need to be put on the record and we should be incredibly proud of them.
	We must take forward issues such as ensuring that girls can go to school, not just up to the age of 11, but up to the age of 14, or whenever. That is where our ambition should be. This debate should have been so much more about the positive future, about building on the fantastic four and three quarter years of this Parliament and reaching the 0.7% goal, and where we will go in the future. It is unbelievably churlish for people to talk disparagingly about the private sector being involved in these things. Are they really having a pop at Diageo, which has taken over from the Guinness Trust? Is that what this has come down to in this Chamber? Some of the people who have made comments in this Chamber should be ashamed of themselves. I cannot believe that they were proud to stand up and make such comments. It is very sad.
	On a more positive note, the important thing is to take forward the next set of goals that this country can agree to, with their great plans for the future. We work with some tremendous charities. Plan UK and
	RESULTS have been superb in educating and showing parliamentarians what is going on out there in the world: what is going on in Ethiopia with TB, in Tanzania with farming, with Oxfam and other such organisations. That is where the future lies. I hope that we never have another of these debates with this tone. It demeans Parliament and I am really sorry that it happened today. The future is with us and we can explain to all the voters that it is in our country’s best interest for other countries to develop and have a peaceful and safe future. If we can do that with some of our taxpayers’ money, that is the right thing to do.

Mark Lazarowicz: My hon. Friend the Member for Stoke-on-Trent North (Joan Walley), who chairs the Environmental Audit Committee, referred to the report we have produced on the sustainable development goals. Given the nature of business during the next few months, it will probably not even receive a Government reply and it certainly will not get much time for debate, so I would like to highlight a few of the report’s recommendations, to which the Minister and the shadow Minister might respond.
	We strongly took the view that it was important that there were stand-alone climate change goals in the new sustainable development goals. I know they are currently there and I hope that the Government and the Opposition will confirm that they will recognise the importance of maintaining those in the final package.
	In terms of specific recommendations, we emphasised the importance of phasing out the subsidies to carbon intensive energy sources in developing countries. There is no point in our having tight emissions targets if we then encourage activities that produce increasing carbon emissions anywhere in the world, and certainly in developing countries. We emphasise the importance of ensuring there are the highest standards of environmental protection in trade deals. Only today, the Committee took evidence on the new Transatlantic Trade and Investment Partnership proposals and the need to ensure that they do not jeopardise environmental standards, both within the European Union and the United States, and in the consequential effects on developing countries.
	We emphasise the importance of the UK leading efforts to improve air quality in cities. We know that in the UK, the numbers dying from poor air quality are much greater than originally realised, and that is even more of an issue in developing countries, with urbanisation continuing to develop in many parts of the world. Once again, I hope that is an issue on which the Government will take a lead.
	We emphasise the importance of—the phrase we use may not be the most elegant but nevertheless it highlights what we want to say—decoupling economic growth from an increase in natural resource use. I hasten to add that we are not against economic growth, but we want to get away from the idea that economic growth has to be accompanied by increasing resource use, and increasing climate emissions as well.
	We recommended an annual report on the impact of the international climate fund. That is an important initiative, but it has to be done properly to ensure, apart from anything else, that we do not waste the money when it is going to the most effective uses.
	It is important to establish marine protected areas in the UK overseas territories. The only marine protected area that has been established so far is in the Indian ocean territories, and that is more to do with the Chagos islanders and other issues than with having a marine protected area in that part of the world.
	There is a very important recommendation on engaging young people in the UK with the renewed sustainable development goals and supporting activities that raise awareness about sustainable development. I am concerned about the future of the international citizen service—an initiative initially promoted by the previous Government that has been much promoted by the current Government. I hope the Minister can give a commitment that the UK will continue to support the international citizen service after this year, when it is due to terminate. That is important. We all know from our work in our constituencies that the genuine interest among schoolchildren and other young people underpins the commitment across the Chamber and across the country to supporting our international development goals.

Tom Clarke: Given the discussions about whether there ought to be debates on this, does my hon. Friend agree that it is vital that we have a debate before the Paris conference in order to give strength to our representations?

Mark Lazarowicz: Absolutely. Public debate, engagement and support strengthen the hand of any Government in international negotiations such as those later this year.
	Last week, I was fortunate to visit Leith Walk primary school in my constituency, where the students and their teachers had been involved in the important and valuable send my sister to school initiative. I am sure that we all have in our constituencies the same experience of young people being very committed to taking action on these issues. I hope that the Government will continue to support that through the continuation of the international citizen service.
	It is important to be non-partisan on this issue, as far as possible, and to ensure that we have the widest consensus among political forces in this Chamber and outside. At the same time, it is also right to criticise and challenge a Government where there are failings. That is why I intervened on one of my colleagues about refugees from Syria and, bluntly, the Government’s failure to live up to what was promised just over a year ago. I know that is not the direct responsibility of the International Development Secretary, but the failure of the Home Secretary and her Ministers to live up to what we promised is a blot on our otherwise good record in supporting refugees and international development. I recognise that the Secretary of State cannot today suddenly reverse the Government’s record to date on supporting Syrian refugees, but I hope that she will have a word with her ministerial colleagues to ensure that we now live up to the Government’s commitments, which I believed at the time were made in good faith and which were supported across the House. I would like a change in our actions to be consistent with the policy that the Government followed just over a year ago.

Jeremy Lefroy: I refer Members to my entries on international development in the Register of Members’ Financial Interests.
	I am delighted that we have this opportunity to debate the sustainable development goals, which are incredibly important. Since 2000, the eight millennium development goals have achieved amazing results. My right hon. Friend the Member for Eddisbury (Mr O’Brien) and my colleague on the International Development Committee, the hon. Member for East Lothian (Fiona O’Donnell), spoke about malaria. Since 2000, there has been a fall in the number of malaria deaths per year from over 1 million to about 600,000. That is still far, far too many. Nevertheless, several million people, mainly women and children, are still alive today because of the results of the work that has been done through the MDGs. I congratulate this Government on increasing the amount spent on combating malaria from £150 million a year to approximately £500 million this year, in fulfilment of a commitment made in the Conservative party manifesto. That was a direct result of the millennium development goal. If it had not been there, this would not have happened.
	The twin goals of the World Bank are, by 2030, to eliminate absolute poverty and to promote shared prosperity and thereby reduce inequality. Those goals are absolutely vital. This afternoon, the International Development Committee had the honour of questioning the Secretary of State for our report on jobs and livelihoods. In evidence to the Committee, the Department has said that the world must create 600 million new jobs not by 2030, but by 2020, which is the end of the next Parliament should it run for a full five years. For me, that is the major challenge that the world faces, and so many of the sustainable development goals are pertinent to it, which is why I will concentrate on it today.
	Without peace and governance—goal 16—there is no prospect of sustainable development or of creating those jobs. Let us remember that Somalia is improving at the moment thanks to the work of the peacekeepers from Uganda and Burundi, each of which has lost hundreds of its soldiers in that effort, and that some of those soldiers have been trained by the United Kingdom. Peace and governance are therefore absolutely critical.
	Jobs and livelihoods are referred to in goals 1, 2 and 8, particularly in relation to agriculture, which sustains so many hundreds of millions of people. It is vital to give priority to the work on jobs and livelihoods. I congratulate the Secretary of State and her predecessor, the right hon. Member for Sutton Coldfield (Mr Mitchell), on doing so, and I also congratulate the previous Government, who set out on that course.
	Following on from that work must come taxation, which is mentioned in goal 17.1, because only through fair taxation can we provide the revenues to bring about the public goods necessary for sustainable development.
	Health systems have quite rightly been mentioned. We have recently published a report on them. It is vital to ensure that the direct work done on malaria, TB, HIV and neglected tropical diseases is reflected in horizontal work across health systems. We must not forget about strengthening health systems while we are tackling diseases.

Kate Green: Will the hon. Gentleman take the opportunity to note the importance of investing in and supporting mental health services in developing economies?

Jeremy Lefroy: That is absolutely critical, and I entirely agree that it must come out in the SDGs.
	Goal 4 deals with education, without which people will not be in a position to fill the jobs and create the wealth needed. My constituency neighbour, my hon. Friend the Member for Stone (Sir William Cash), has done sterling work in piloting through his Bill on gender equality. I was delighted to hear the Secretary of State say in Committee today that it looks as though we are spending roughly 50% of the international development budget on women and girls. It would be great to have that confirmed for the record.
	Finally, as many Members have said—including the hon. Member for Stoke-on-Trent North (Joan Walley), whose work in this area I greatly respect—unless we tackle climate change, it will be impossible to live in a sustainable world and to create the jobs and livelihoods that everybody needs.
	The motion calls on the Government
	“to show global leadership on tackling the causes of poverty inequality and climate change.”
	I am afraid that I cannot support the motion, because I believe that the Government are already showing such leadership under the Secretary of State and the Prime Minister, and with the support of the whole House.

Kerry McCarthy: I am very pleased that Labour has called this debate to highlight a particularly momentous year for international development, with the launch of the sustainable development goals and the climate change talks in Paris in December. Much was achieved under the previous development framework of the millennium development goals, but much more of course needs to be done. In the time available, I want to concentrate on a few of the goals.
	Goal 2, on hunger, has among its targets that the world should ensure that
	“food systems are stable, sustainable and produce enough nutritious food for all”,
	and that
	“all people can access and consume adequate, affordable and nutritious food.”
	Given that the sustainable development goals, unlike the MDGs, will apply to developing and developed countries, I am keen not only for such targets to be implemented in the developing world, but for them to be addressed in the UK, where food poverty is very much an issue and there are real concerns about child malnutrition.
	There are also concerns about food distribution. The International Development Committee produced an excellent report on food security. We produce more than enough calories to feed a world population of 9 billion, which we are estimated to reach by 2050. There is enough food, but it does not get to the people who need it. We have obesity on the one hand, and starvation and malnutrition on the other. According to the UN, more than a third of the food that is produced—about 1.3 billion tonnes—ends up being wasted. That is a scandal.
	The food that is wasted, according to Tristram Stuart’s excellent book of 2009, “Waste: Uncovering the Global Food Scandal”, is enough to feed 3 billion people. That would still leave enough surplus for countries to provide their populations with 130% of their nutritional requirements. The UN’s Food and Agriculture Organisation estimates that every year the production of food that is wasted generates 3.3 billion tonnes of greenhouse gases and uses up to 1.4 billion hectares of land, which is 28% of the world’s agricultural area. Globally, the blue water footprint for the agricultural production of food waste is about 250 km3, which is more than 38 times the blue water footprint of USA households.
	That brings me to goal 9, which is that,
	“All people enjoy a sustainable, healthy and resilient environment”,
	and goal 10, which is that,
	“The world is on track to avoid dangerous climate change and is less vulnerable to its impacts”.
	The targets that are attached to goal 9 are admirable:
	“Reduce ecosystem degradation and biodiversity loss… Manage natural resources that are essential for people’s basic needs within their natural limits… Embed sustainable consumption and production in national policies and practice.”
	Again, those goals apply not just to developing countries, but to the UK. There is much that we could do and need to do to meet those targets.
	Goal 10 is about linking human development with the future of the planet. As has been said, we cannot eradicate poverty unless we tackle climate change. It has an impact in many ways. It affects whether a country can produce enough food to feed its people and whether people can move beyond subsistence farming to being able to make a living from farming. It affects the water supply. For example, we can look at the impact that climate change and glacial melt are having on the mountainous areas of Nepal and Tibet, which are sometimes described as the third pole because they make up the third biggest ice mass after the Arctic and Antarctic. It causes natural disasters that range from droughts to floods and that include typhoons, tropical storms and landslides due to soil degradation.
	Yesterday, I met seven of the eight ambassadors and chargés d’affaires from central American countries and last week I met the high commissioner from the Maldives. Those countries see the impact of climate change on their lives on a daily basis. The Maldives might no longer exist if we do not meet the 2° target. That is why what happens in Paris at the end of the year is so important.
	I have asked the Secretary of State at International Development questions about the Government’s commitment to a stand-alone climate change goal. I admit that I am still slightly confused. I have heard from other people that we will probably accept all 17 goals. However, in her response to me, the Secretary of State suggested that she would prefer to see sustainability mainstreamed across the post-2015 framework. I agree that it is important that the issue is mainstreamed, as it ought to be across all Departments in the UK, but that does not mean that there is no need for a lead Department on climate change in the UK. In the same way, I believe that a stand-alone sustainable development goal on climate change would help to focus minds, keep the issue firmly on the agenda and ensure that we do not drop the ball on what is a very important issue.

Anas Sarwar: As we have heard from a number of speakers, 2015 has the potential to be an historic year for international development. The international community will come together in September to agree the sustainable development goals and at the end of the year to agree a framework to tackle climate change. That will happen just in year one of the next Parliament. The next five years must be about not just making the right agreements but, crucially, delivering on them. That will require commitment, energy and, crucially, leadership on the international stage. We will need the ability to set the agenda, to advocate and persuade, to build alliances, and to use our influence to make a difference for some of the world’s poorest and most vulnerable people.
	I echo the comments of my right hon. Friend the Member for Dulwich and West Norwood (Dame Tessa Jowell), who rightly mentioned how we strove for consensus. Let us remember that the consensus was built by the last Government; it was not there from the beginning. It is also important to recognise that our criticism of the Government is not that they do not act on the international stage on international development—of course they do and we welcome that—but it is the force of their advocacy and leadership. Compare that to the last Labour Government. We created the Department for International Development. We trebled the aid budget. We founded the Global Fund to Fight AIDS, Tuberculosis and Malaria. We led on cancelling debt. We created the Extractive Industries Transparency Initiative and we drove the efforts on the millennium development goals.
	In contrast, the Government have failed to show leadership at home, never mind abroad. They had a clear manifesto commitment to legislate on 0.7% gross national income in international aid—[Interruption.] If the hon. Member for Skipton and Ripon (Julian Smith) listens, he will find that we are much more in agreement and perhaps he too will be open to transparency, accountability and debate—things that both sides of the House welcome. The 0.7% aim was in the Conservatives’ manifesto and the coalition agreement. Thankfully, the right hon. Member for Berwickshire, Roxburgh and Selkirk (Michael Moore) delivered a Bill on 0.7% and I pay tribute to him and all the Members who got behind the Bill to make sure that we delivered on our international obligations. I just wish that it had been done in Government time, which would have shown more leadership—

David Evennett: The Government supported it.

Anas Sarwar: Well, we should also highlight the fact that more Labour MPs voted in favour of the Bill than MPs from every other party combined.
	With crucial negotiations and agreements coming up, I want the next Government to be drivers, not passengers. The new sustainable development goals must go faster to eliminate extreme poverty and focus on tackling inequality, as mentioned by my hon. Friend the Member for Stoke-on-Trent North (Joan Walley). To add to that, we would prioritise universal health coverage, human rights for all, including women, children and the disabled, and the effects of climate change.
	Access to health care should be based on a person’s need, not their ability to pay. It should be a right, not a privilege. That is why, unlike the Government, we will support a stand-alone goal on universal health coverage. Universal health coverage does not just help improve health outcomes, it would help reduce inequality and stop 100 million people a year from falling into poverty. I pay tribute to two Conservative Members who spoke passionately about causes that are dear to them. The right hon. Member for Arundel and South Downs (Nick Herbert) has shown a tremendous commitment to the fight against tuberculosis and raised the important point of multi-drug resistance. Universal health coverage could be an important element of that fight in the future. I had the privilege of serving on the International Development Committee with the hon. Member for Stafford (Jeremy Lefroy) for almost 18 months, and he spoke of his commitment to the issue of malaria, and the work done by the last Government and this to tackle it. I know first hand, from our conversations and from serving on the Committee, of the good work that he does. I am sure that that will have the support of both sides of the House and, I hope, the next Labour Government.
	Negotiations on universal health coverage are also about resilience to humanitarian disasters or outbreaks of disease, and we have already heard about the difference that can make. Nigeria, which has invested strongly in building its health systems, was able to contain and beat the Ebola virus, but Sierra Leone—let us remember that the Government cut support for that country—has struggled to cope, resulting in loss of life and the need for even greater support from the Government and the international community.
	On the issue of Ebola, I wish to put on record again, on behalf of both sides of the House, our thanks to and appreciation of Pauline Cafferkey and all those from the United Kingdom who volunteer to go and help in the fight against Ebola. Pauline is an example of a real hero in our community, and I am sure that we all want to send her our best wishes as she recovers from Ebola and returns home to Rutherglen in Scotland.
	I echo the comments made by my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who rightly paid tribute to our tremendous staff at the Department for International Development. They are heroes in their own right, struggling and fighting to make a difference to people’s lives across the world.

Pauline Latham: The hon. Gentleman mentioned that we had cut aid to Sierra Leone. We have spent more money on health in Sierra Leone in every year of this Parliament than the previous Government. Where is he getting his figures from? It is duff information.

Anas Sarwar: It is good to see the hon. Lady taking part in the debate. She was not here earlier when we were discussing that very important issue. She may want to refer to the House of Commons Library and to a Westminster Hall debate with the Minister of State, Department for International Development, the right hon. Member for New Forest West (Mr Swayne) on this important issue. In that debate, the Minister admitted he did not know how much money the Government were spending in Sierra Leone. He also said he would go away and find out. I am still waiting for an answer.
	Another point raised with the Minister in that debate was how we recruit from developing countries to our NHS. The Minister said he would investigate and come back on that. I would be interested to hear the result of that investigation. There is a sad irony in the UK recruiting one in four doctors trained in Sierra Leone into our NHS, when it has an acute need itself. Our NHS—thought of, created and saved by Labour—is the envy of the world. The previous debate is proof enough of this Government’s shoddy commitment to it and its values. That is why only Labour can be trusted to make the case for universal health coverage at home and abroad.
	Another priority is to put women and girls at the heart of the sustainable development goals. We would like gender equality, access to education, clamping down and taking action against female genital mutilation, and making sure every child is protected from slavery or abuse to be included.
	On private sector development, Labour agrees that a thriving and free private sector is vital to the elimination of poverty, but it cannot be based on the ideology of trickle-down economics. Labour believes the most sustainable and dignified route out of poverty is work. We must ensure that that also means decent pay, fair conditions and the freedom to join a trade union. That is why we will reverse the Government’s decision to slash funding to the International Labour Organisation. DFID’s spending on private sector development in 2011-12 was £549 million. That now sits at £1.8 billion—a fifth of DFID’s budget.
	At the same time, we have seen Ministers completely fail to ensure value for money or transparency, a point raised by my hon. Friends the Members for East Lothian (Fiona O'Donnell) and for Llanelli (Nia Griffith). It is very difficult to establish what DFID is spending that money on. It is channelled through private bodies such as the Private Infrastructure Development Group, a multilateral organisation that is considerably less transparent. Government Members may criticise Labour’s approach, but the National Audit Office and the Government’s own Independent Commission for Aid Impact warn that oversight of this funding is inadequate and risks wasting taxpayers’ money. We await the Public Accounts Committee report tomorrow.
	It is completely unacceptable that any Government Minister can fail to answer basic questions on how we spend £2 billion of taxpayers’ money. It is not just the Government who have a responsibility, but companies too. It is an absolute scandal that every year three times as much is lost in tax revenues to developing countries than the global aid budget combined. That is why we must make tackling tax avoidance a priority at home and abroad. We must look at supply chains adopting the same principles we apply in this country.
	My hon. Friends the Members for Bristol East (Kerry McCarthy) and for Cardiff South and Penarth (Stephen Doughty), and many other colleagues, raised the issue of climate change. Labour will, unlike this Government, put the fight against climate change front and centre of international agreements. We will use the G8 in Germany to push for climate change to be a permanent standing item at the UN Security Council. It will be on the agenda of every meeting with world leaders here in the UK. Leading on the sustainable development goals; leading on climate change; leading on private sector
	development; leading on universal health coverage; and leading right around the world. That is the leadership this country needs.

Desmond Swayne: This debate has, to a large extent, been wrested from the Opposition Front-Bench team and rescued by the many excellent contributions we have heard. We began with the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell), who rightly pointed out the importance of pre-school education, and then my right hon. Friend the Member for Eddisbury (Mr O’Brien) brought the benefit of his expertise in stressing the need for security. I always welcome the experience and wisdom of the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made an excellent point about development education. I hope the project that our schools go through every summer, Send My Friend to School, spreads to parents, because the children’s enthusiasm for the agenda is an example to us all.
	I thank the right hon. Member for Gordon (Sir Malcolm Bruce) for his excellent speech. He hit the nail on the head, as one would expect from a Select Committee Chairman of 10 years, and I shall return to his speech shortly, if time allows, because it was a seminal contribution. The hon. Member for East Lothian (Fiona O’Donnell), who rightly concentrated on malaria, made some important points, and my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) concentrated on tuberculosis and brought the benefit of his long experience, as did my hon. Friend the Member for Stafford (Jeremy Lefroy), who has long been committed to these issues.
	The hon. Member for Llanelli (Nia Griffith) concentrated on the importance of our taking a lead and asked several questions about TradeMark Southern Africa. The Independent Commission for Aid Impact, which we set up specifically to examine what was going on, drew attention to the problems with the project, and, as a result, my right hon. Friend the Secretary of State cancelled it. The hon. Lady also mentioned the PIDG, which, I recollect, was set up in 2002—perhaps when the hon. Member for Cardiff South and Penarth (Stephen Doughty) was in the Department. However, we will attend to the issues raised in the NAO report. I share some of the concerns, but we need to bear in mind the huge leverage of the PIDG in getting private finance into poor countries. In her short, but pithy speech, the hon. Lady also asked about the ILO, as did other hon. Members. We took the decision we did following the multilateral aid review, but we still work closely with the ILO—in Bangladesh, for example.
	I thought the remarks of the hon. Member for Cardiff South and Penarth on fair trade were particularly pithy. He rightly drew attention to the false dichotomy between security and defence, and development; they are intimately connected. My right hon. Friend the Member for Banbury (Sir Tony Baldry) gave us the advantage of his 30 years’ experience, including as a Minister, and rightly drew our attention back to climate change and sustainability. The hon. Member for Stoke-on-Trent North (Joan Walley) highlighted the important report from the Environmental Audit Committee and asked several detailed questions. I offer her a trade. I have every intention of reading her report, but perhaps she will read this report: “A New
	Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development”. It is all in here: exactly how every single one of the targets has to be permeated with the key issue of sustainability. We are confident that the goals will be universal and we are ready to play our part: we have a strong cross-Government approach to this agenda, which is crucial to ensuring that all Departments are engaged and that the UK will be well placed to deliver these goals—it says.
	My hon. Friend the Member for South Derbyshire (Heather Wheeler) raised our sights and our ambition, pointing the debate back to the millennium goals. The hon. Member for Edinburgh North and Leith (Mark Lazarowicz) focused our attention back on the Environmental Audit Committee report, but also made an excellent point about the international citizen service. He is right to praise that excellent initiative, which we are now considering what we can do to expand. I hope I have been able to reassure him on that point.
	The hon. Member for Bristol East (Kerry McCarthy) brought her long experience and knowledge of nutrition to this debate, but when she went on to climate change there was an element of criticism. I would point out that we were one of the few countries that constantly tried to get a specific reference to the 2° target back into the goals.
	This has been a very good debate in many respects—[Interruption.] Yes, there is a “but”. I want to return to the opening of the debate. We have a motion before us that seeks to divide the House. I have sat here and listened to all these excellent speeches and searched for the issue of substance that divides us. What have we got in the motion that seeks to divide us? The 0.7% target? We were all in the same Division Lobby on 0.7%. The only gripe is one of process—what kind of Bill it was.
	We are also absolutely united in our approach to the importance of health. I pay tribute to the last Labour Government, who increased the bilateral spend on health. We have continued that; so much so that in the last seven years, bilateral health expenditure has doubled and now represents almost a quarter—23%—of our spend. We have already heard about the £1 billion commitment that has been made to the global fund. That will fund life-saving treatment for an additional 750,000 people with AIDS. There is no issue between us on health. [Interruption.] The hon. Member for Luton South (Gavin Shuker) asks, “What about the SDGs?” We canvassed hard and we have succeeded in getting specific targets and goals on health care.
	When it comes to climate change, there is again no division of substance between us. On equality, there is the principle of no one being left behind before a target can be met. Again, there is absolutely no division of substance between us.
	I come back to the speech by the Chairman of the Select Committee. He pointed out that we now have some 17 goals and 169 targets, when it was the ambition of the Secretary-General that we would have something small and understandable—something that we could all get behind and campaign on, something that we could measure and something that we could hold Governments to account on. That is what we should have been talking about tonight: how we get behind that agenda. They wasted the opportunity—

Rosie Winterton: claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.
	Question agreed to.
	Main question accordingly put.
	The House divided:
	Ayes 200, Noes 290.

Question accordingly negatived.

Business without Debate

DELEGATED LEGISLATION

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Public Service Pensions

That the draft Judicial Pensions Regulations 2015, which were laid before this House on 11 December 2014, be approved.—(Gavin Barwell.)
	Question agreed to.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Animals

That the draft Microchipping of Dogs (England) Regulations 2015, which were laid before this House on 11 December 2014, be approved.—(Gavin Barwell.)
	Question agreed to.

HORMONE REPLACEMENT THERAPY IMPLANT

Motion made, and Question proposed, That this House do now adjourn.—(Gavin Barwell.)

Tracey Crouch: I am very pleased to have the opportunity this evening to speak on behalf of not only my constituents but many women across the country on the issue of commissioning and funding of the hormone replacement therapy implant.
	While I appreciate that for the overwhelming majority of women experiencing the menopause alternative HRT treatments are perfectly effective in addressing their symptoms, for a small number this is not the case, and the impact is significant. This issue was first brought to my attention by a group of my constituents who were being treated with the implant from the well woman clinic at Lordswood community healthy living centre in my constituency. In March 2014, after Medway clinical commissioning group announced that it would no longer be providing funding for the insertion of HRT implants, they sent me a copy of a petition signed by 200 women, one of whom has since sadly passed away.
	After receiving the petition, I met a number of the individuals concerned to discuss why the alternative treatments were inadequate. They described the effect on their quality of life of no longer having access to the implant, and the problems that they had experienced with other formats of the therapy not addressing their menopausal symptoms.
	The purpose of today’s debate is not to advocate access to the implant for all women going through the menopause. I am aware that many women either go through the menopause without any major problems or can sufficiently negate their symptoms with the cheaper licensed alternatives such as patches and gels. However, for a selection of women, the HRT implant provides benefits not addressed by alternative forms of the therapy.
	A small percentage of women are severely affected by this issue. They include women with a history of breast cancer in the family. HRT has been thought to increase the risk of breast cancer, especially when used over long periods of time. However, the implant is seen as a preferable option for those seeking HRT treatment as there is a reduced risk, because it is absorbed directly into the blood and bypasses the liver. They also include women who experience some of the more severe symptoms. Symptoms such as joint pain and depression, which cannot be eased by the other licensed formats of the therapy, can also be improved by the implant. These more severe symptoms can have a huge impact on the quality of daily life and on well-being, affecting factors such as employment and mental health, which have cost and health implications of their own, both to the economy and to the individual. The small percentage of women severely affected by this issue also includes women who suffer from early menopause. This means that they are likely to suffer symptoms over a protracted period, and they have also been seen to have much better results from the implant.
	The personal experience of my constituent Sarah clearly highlights the reality and severity of the effects involved, as well as the benefits that the implant can provide. Sarah King is suffering early menopause. She is a lovely young married mum with three young boys. For most of her life she had been healthy, active and happy,
	but in recent years she suffered a number of accumulating health problems. These included joint pain—to the point of hospitalisation—skin problems, depression, headaches and lethargy. After a number of years of various treatments and no real improvement, she was sent for a simple blood test which revealed extremely low hormone levels, indicating that she was suffering an early menopause.
	Owing to a family history of breast cancer, Sarah was first offered the opportunity to try the HRT implants. Within a short time, all her poor health issues had gone. When the HRT implant service stopped, she tried the HRT patches and then the gel, but neither gave her the same result that she had experienced with the implants. Her health deteriorated to the point that she had to quit her full-time job as a teaching assistant. She started researching on the internet and discovered that the Chelsea and Westminster hospital in London had a specialist menopause clinic and HRT implant service.

Jim Shannon: I thank the hon. Lady for bringing this delicate issue to the House for our consideration. My understanding is that this hormone replacement therapy is available only in certain locations across the United Kingdom. Does she agree that we need consistency of availability, from Aberdeen to London and from Cardiff to Belfast, and that it should be available to everyone?

Tracey Crouch: I am grateful to the hon. Gentleman for his intervention. The implant is no longer uniformly available nationally. The decisions being taken locally are affecting people who might not be able to travel to London, for example. I shall come to that later in my speech.
	Sarah contacted Medway CCG to ask whether it would object to her being referred to the Chelsea and Westminster hospital as an NHS patient. The CCG told her that there was no objection and that the patient’s well-being was its priority. Following that consultation, Sarah had her first appointment at the Chelsea and Westminster on Monday 12 January this year. She was accompanied by her husband, and he was able to tell the medical practitioner who interviewed Sarah what it had been like before she received HRT implants at the Lordswood clinic, what it had been like after she had the implants, and what it had been like to see her health deteriorate again when that treatment was no longer available. He said:
	“I just want my happy, healthy Sarah back.”
	The medical practitioner that Sarah saw said she was an ideal candidate for the HRT implant and did not hesitate in giving it to her during that first visit. Within a week Sarah says she is already feeling much better, and she has now set up a website dedicated to supporting women suffering severe menopausal symptoms. I am sure that Sarah is just one woman of many who have found themselves in this predicament, but not all have had such positive outcomes.
	I would like to take this opportunity to thank the constituents of mine, especially Val Weeden, who have tirelessly researched and campaigned on this issue. They have actively searched for solutions and continuously shared their information with me. They have constantly supported each other through what has clearly been a very tough situation for many. It is extremely unlikely that this issue is unique to my constituency; I am sure that many women across the country and beyond who
	suffer from severe symptoms no longer have access to this potentially life-enhancing treatment because of localised commissioning structures. They may not all come across information for Chelsea and Westminster’s specialised service, and women in the far north or far south of the country who do may struggle to travel to London, at a potentially extortionate cost. Although I appreciate that this is not a cost to be incurred by the health care system, it is one that I would like the Minister to consider today.
	After some research into this issue, I identified that on 5 July 2011 MSD, the only licensed provider of the Estradiol implant here in the UK, issued a letter to GPs stating that it was to cease manufacture of the product. It stated:
	“the company’s global decision to discontinue the manufacturing of Estradiol was made after consideration of commercial factors and the fact that therapeutic alternatives are available in most countries. The decision is not related to a product quality or safety issue”.
	For most women, this issue of cost has no impact on their treatment and well-being, but the 200 women in my constituency, and, I imagine, many others beyond for whom the alternative forms of HRT are not suitable, have been left with a void in their health care. The UK now has no licensed provider for a treatment that enables sufferers to live a normal, high-quality, day-to-day existence.
	I recognise that the lack of a licensed provider is not necessarily a problem, as GPs are able to prescribe unlicensed medicines if they feel there is a special need and an unlicensed provider of the product exists in the UK. However, in my constituency this process has not adequately represented the women for whom this treatment is so important, because when our CCG made the announcement in March 2014 that it would no longer be providing funding, the justification was that 200 women was far too great a number to be treated with an unlicensed medicine when licensed alternatives were available.
	Although I disagree with the idea that an increased demand for treatment somehow de-legitimises its suitability, I am aware of the potential concerns about licensing. However, just because a product is unlicensed, it does not necessarily mean that it is unsafe, as has been highlighted in MSD’s notice of cessation. In fact, in this case the unlicensed treatments being provided have been widely used across the country and the world. The only reason they are currently unlicensed is that the license holder deemed its provision economically unviable.
	That brings me to my conclusion. My constituents found the Chelsea and Westminster clinic through independent research on the internet. That is not a good enough procedure to ensure that women have access to the vital services they need in our health care system. I, for one, recognise the positive changes that this Government have made to our health care system—namely the emphasis on the importance of well-being. I also believe that, for the most part, our doctors are best placed to commission our local services, but this case is an example of where the economics of devolved commissioning are perhaps having a negative impact on specialist services.
	The Chelsea and Westminster clinic is proof that there is clearly a recognised medical need for the HRT implant to be made available, as a uniquely successful
	treatment, to a significant minority of women. I therefore ask the Minister to commit to take steps to ensure that our shared vision of our health care system is a reality for all who use it, including these women. I urge the Minister to take steps to make sure that this specialised service is available to all women who may need it, in an appropriate location, and that appropriate referrals take place. To follow any actions that he may take on this issue, will he make a commitment to publish new guidance or write to GPs to inform them about best practice for their patients in this position.
	Looking forward, we also need to understand early menopause better and how it may be affecting women from an earlier age. I urge the Minister to engage with national organisations such as the Daisy Network, which was set up for this age group to see how best we can do that. We also need more research into severe menopausal symptoms and treatment for them. Will the Minister commit to look at this whole area of concern?
	Finally, I thank Val, Sarah and the rest of my constituents who have campaigned tirelessly on this issue. Their support has enabled me to raise this issue in the House not just for them but for many, many women across the nation in similar circumstances.

Daniel Poulter: I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this debate on the funding of hormone replacement therapy implants. She gives me the opportunity to discuss the issues she has raised on behalf of her constituent, Sarah, and others more generally.
	Hormone replacement therapy is effective for treating women who are entering the menopause and experiencing hot flushes and night sweats as well as sleep and mood disturbances. There are a number of different types of hormone replacement therapies available, including an oral tablet taken daily, or a transdermal patch applied once or twice weekly.
	We should acknowledge that there are risks for those who are prescribed hormone replacement therapy, and the guidance of the National Institute for Health and Care Excellence suggests that, among other risks, there is a small increased risk of breast cancer, stroke and gallbladder disease.
	Turning to the issues raised today concerning hormone replacement therapy implants, I have been advised by the Health and Social Care Information Centre that the number of items prescribed and dispensed for hormone replacement therapy implants has been declining since 1996, from around 36,700 prescription items per year to around 5,300 in 2010, the year prior to the licence being withdrawn. HRT implant prescriptions are now down to negligible levels.
	HRT implants are no longer routinely offered as a treatment for menopausal symptoms, as my hon. Friend said, and that has been the case since 2011 when the manufacturer of the licensed product, the pharmaceutical company MSD, stopped making the implants. The decision to cease manufacture was based on two main factors. First, therapeutic alternatives are available in the UK, including tablets taken by mouth, patches and gels. Secondly, cost-effective manufacturing processes are unsustainable because few countries use the implant formulation.
	GPs and prescribers were advised in 2011 that treatment should be continued until a discussion could take place between the patient and their prescriber. I understand that most GPs and prescribers reviewed their patients at that time and agreed suitable alternative treatments to switch to. The Medicines and Healthcare products Regulatory Agency advises me that the only HRT implant preparations now available are not licensed for use in England, as my hon. Friend pointed out.
	There has been a change in the prescribing culture surrounding HRT implants. In the past, they were popular as they gave a steady amount of oestrogen over a period of time and women did not experience fluctuating hormone levels. However, the insertion of HRT implants requires a small surgical procedure, and that can only be done by certain clinicians. Some women increased their tolerance to HRT as a result of having an implant, and returned for higher and higher doses at reducing intervals.
	Newer hormone replacement therapy patches now provide steady amounts of oestrogen hormone without the disadvantages of the implant, and this phenomenon of HRT tolerance occurs less frequently.

Tracey Crouch: I understand what the Minister is saying, but does he recognise that some women have allergic reactions to the patches? Certainly, my constituents who came to see me found that neither the patches nor the gel offered a suitable alternative to the implant, not least because the patches often fall off or there is some kind of reaction to them.

Daniel Poulter: Indeed. My hon. Friend makes a fair point, and I shall make some reassuring comments in that regard in a moment. It is possible to have a reaction to a device or implant, and one would hope that if people have an allergy or reaction to any product, that would be taken into account before it is used. If it causes discomfort, irritation or any adverse reaction, its use should be discontinued and alternative therapies considered.
	Clinical commissioning groups are responsible at local level for commissioning the majority of NHS services, and decisions about those services should be made, we would all agree, as close to patients as possible by those who are best placed to work with the patients and the public to understand their needs. Local NHS commissioners now have the freedom and autonomy to take responsibility for meeting the needs of patients in their area, and other health care professionals can work with the CCG, including in secondary care, to help to integrate and join up services more effectively. While clinical commissioning groups are led by primary care professionals, they are also guided by the expertise of other local clinicians.
	I understand that my hon. Friend’s local CCG—Medway CCG—released new guidance on HRT implants in 2014. The guidance states that from April 2014, patients will no longer be able routinely to receive hormone replacement therapy implants from their GP. Medway CCG has advised me that the guidance was developed for HRT treatment following clinical input and review through a clear governance process. Because HRT implants are no longer licensed and more suitable alternatives are generally available, the CCG decided that it would no longer pay GPs for inserting such implants from 1 April 2014. The CCG’s policy is in accordance with General Medical Council guidance on prescribing unlicensed
	medicines, and my hon. Friend will appreciate that medical professionals and doctors have to have regard to those requirements under the licence that they hold, and because they are regulated by the GMC. The CCG has assured me that it does not prevent doctors from inserting an HRT implant if they think it is clinically necessary for an individual patient, having assessed their needs and tried alternatives, and providing that they have sufficient evidence to demonstrate the treatment’s safety and effectiveness.
	In exceptional circumstances, where a licensed medicine is considered unsuitable or ineffective for an individual, I would expect those patients to be referred for expert opinion. I am pleased that that is exactly what happened in Sarah’s case, and that Chelsea and Westminster hospital provided her with excellent care and support. We would expect a similar process to be in place in other CCGs. If someone needs more expert support and care, perhaps because they are suffering from the menopause and their GP finds their symptoms and presentation complicated, there should always be a facility for referral to specialist care and support. What happened in Sarah’s case—thankfully, it has resulted in a positive outcome for her—is available at other centres of excellence. Expert care and advice is there, and available for patients.
	Medway CCG has written to GPs locally to issue information that they can share with all patients who are still using HRT implants, and to ask them to discuss alternative forms of HRT with them at their next routine appointment.
	The CCG advises me that patients should be referred to a gynaecologist for expert opinion if the GP and their patient consider that there is no suitable alternative to the HRT implant. I hope that that is reassuring to my hon. Friend. At a local level the CCG has taken the issue seriously and has written to local GPs and reminded them of the importance of reviewing the current treatment plan for women who have the implant, but if they need more specialist support and advice, to make sure that a referral is made to a specialist centre of care. That process should be available to patients throughout the country. Where specialist support is required, CCGs should routinely refer those patients on. That is part and parcel of good medical practice.
	Most of the time, HRT therapy and the expertise of GPs in supporting patients through menopause is enough for the majority of patients, as my hon. Friend outlined, but sometimes there is a need for more specialist support. Centres of excellence such as the Chelsea and Westminster can provide that and consider alternative treatments and therapies where they may be appropriate.
	I hope my hon. Friend finds that reassuring. I thank her once again for bringing the issue to the attention of the House. I hope I have been able to provide some reassurance to her on the issues she raised regarding support for women in Medway who need HRT therapy and potentially implants, and more generally on the process that is in place to ensure that women who need specialist care and support can receive it, and that all CCGs and all doctors would always be mindful to take the right action for the patients they look after.
	Question put and agreed to.
	House adjourned.